Online Program

Retention of participants in opiate substitution programs in low and middle-income countries: An international systematic review

Tuesday, November 5, 2013

Jonathan Feelemyer, MS, The Baron Edmond de Rothschild Chemical Dependency Institute, Icahn School of Medicine at Mount Sinai, New York, NY
Don C. Des Jarlais, PhD, The Baron Edmond de Rothschild Chemical Dependency Institute, Icahn School of Medicine at Mount Sinai, New York, NY
Kamyar Arasteh, PhD, The Baron Edmond de Rothschild Chemical Dependency Institute, Icahn School of Medicine at Mount Sinai, New York, NY
Holly Hagan, PhD, Center for Drug Use and HIV Research, New York, NY
Background: Opiate substitution therapy (OST) is a key component in overdose prevention, reducing opiate use and risk of blood borne virus infection. By retaining participants in OST programs for longer periods of time, more permanent changes in drug use and risk behavior can be achieved. Studies in high income countries have established a 50% average12-month follow-up retention rate as an indicator of a successful OST program. However, we do not have the same systematic understanding of OST program participant retention in low and middle-income countries (LMIC).

Methods: Utilizing PRISMA guidelines we conducted a systematic review to identify OST program studies that measured retention, over time, for participants in OST programs in LMIC. Retention was measured for participants by length of follow-up, type of OST treatment, and OST dosage.

Results: A total of 58 OST program studies were included in the review. Overall average retention after 12 months was 54.3%. Overall average retention was moderately good for both buprenorphine (48.3%) and methadone (56.6%), after 12 months of treatment. Among programs utilizing methadone, there was no statistically significant difference in average retention by dosage level, and the ten highest and lowest dosage programs obtained similar average retention levels after 12 months.

Conclusion: LMIC have successfully achieved the average 50% retention minimum among OST participants after 12 months, and average retention in LMIC is comparable to established OST programs in high-income countries. These results are promising, as higher retention over time is associated with greater changes in drug use and associated risky behaviors.

Learning Areas:

Biostatistics, economics
Public health or related research

Learning Objectives:
Compare Retention of opiate substitution program participants in low middle income countries Evaluate if dosage of pharmacologic opiate substitution treatment affects retention of participants Evaluate if pharmacologic substance type (methadone vs. bupenorphine) affects retention over time Compare overall retention of participants in low income country programs to long-established programs in high income countries

Keyword(s): Drug Abuse Treatment, Low-Income

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have conducted systematic reviews in the field of HIV/AIDS and opiate abuse for nearly four years and have published multiple articles on topics related to this specialized population. I have also presented on similar populations at previous APHA conferences in the HIV/AIDS sections.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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