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01.12.2018 | Research | Ausgabe 1/2018 Open Access

Substance Abuse Treatment, Prevention, and Policy 1/2018

Strategies to control HIV and HCV in methadone maintenance treatment in Guangdong Province, China: a system dynamic modeling study

Zeitschrift:
Substance Abuse Treatment, Prevention, and Policy > Ausgabe 1/2018
Autoren:
Xia Zou, Yong Xu, Wen Chen, Yinghua Xia, Yin Liu, Cheng Gong, Li Ling
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s13011-017-0140-3) contains supplementary material, which is available to authorized users.

Abstract

Background

Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections among methadone maintenance treatment (MMT) participants remain high. Optimized HIV and HCV prevention strategies for MMT clinics in resource-limited regions are urgently needed. This study aims to develop an MMT system dynamic model (SDM) to compare and optimize HIV and HCV control strategies in the MMT system.

Methods

We developed an MMT-SDM structure based on literature reviews. Model parameters were estimated from a cohort study, cross-sectional surveys and literature reviews. We further calibrated model outputs to historical data of HIV and HCV prevalence among MMT participants in 13 MMT clinics of Guangdong Province. Lastly, we simulated the impact of integrated interventions on HIV and HCV incidence among MMT participants using the MMT-SDM.

Results

The MMT-SDM comprises MMT clinics, MMT participants, detoxification centers, and HIV and HCV transmission, testing and treatment systems. We determined that condom promotion was the most effective way to reduce HIV infection (2013-2020: 2.86% to 1.76%) in MMT setting, followed by needle exchange program (2013-2020: 2.86% to 2.56%), psychological counseling (2013-2020: 2.86% to 2.71%) and contingency management (2013-2020: 2.86% to 2.72%). Health education had marginal impact on reducing HIV incidence among MMT participants (2013-2020:2.86% to 2.84%) from 2013 to 2020. By contrast, psychological counseling (2013-2020: 7.54% to 2.42%) and contingency management (2013-2020: 7.54% to 2.96%) had been shown to be the most effective interventions to reduce HCV incidence among MMT participants, followed by needle exchange program (2013-2020: 7.54% to 5.76%), health education (2013-2020: 7.54% to 6.35%), and condom promotion program (2013-2020: 7.54% to 6.40%). Notably, HCV treatment reduced HCV incidence by 0.32% (2013-2020: 7.54% to 7.22%).

Conclusions

In conclusion, we generated a valuable system dynamic model to analyze the Chinese MMT system and to guide the decision-making process to further improve this system. This study underscores the importance of promoting condom use in MMT clinics and integrating psychosocial interventions to reduce HIV and HCV infections in MMT clinics in China.
Zusatzmaterial
Additional file 1: Figure S1a. Causal diagram of MMT clinics, participants and detoxification centers. Figure S1b. Causal diagram of HIV/HCV transmission. Figure S1c. HIV testing and treatment systems causal diagram. Figure S1d. Causal diagrams of HIV and HCV testing and treatment systems. Figure S2a. Stock and flow diagram of MMT clinics, participants and detoxification centers. Figure S2b. Stock and flow diagram of HIV and HCV testing and treatment systems. Figure S2c. Stock and flow diagram of HIV transmission system. Figure S2d. Stock and flow diagram of HCV transmission system. Table S1. Parameters of MMT dynamic model. Table S2. System dynamic equations of the MMT system dynamic model. Table S3. Effectiveness of health education, psychological counseling, contingency management, needle exchange program, condom promotion, ART and HCV treatment. (PDF 1349 kb)
13011_2017_140_MOESM1_ESM.pdf
Literatur
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