TY - JOUR
T1 - Retention of participants in medication-assisted programs in low- and middle-income countries
T2 - An international systematic review
AU - Feelemyer, Jonathan
AU - Des Jarlais, Don
AU - Arasteh, Kamyar
AU - Abdul-Quader, Abu S.
AU - Hagan, Holly
PY - 2014/1
Y1 - 2014/1
N2 - Background and aims: Medication-assisted treatment (MAT) is a key component in overdose prevention, reducing illicit opiate use and risk of blood-borne virus infection. By retaining participants in MAT programs for longer periods of time, more noticeable and permanent changes in drug use, risk behavior and quality of life can be achieved. Many studies have documented retention in MAT programs in high-income countries, using a 50% average 12-month follow-up retention rate as a marker for a successful MAT program. This study contributes to a systematic understanding of how successful programs have been in retaining participants in low- and middle-income countries (LMIC) over time. Methods: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic literature search to identify MAT program studies that documented changes in retention over time for participants in buprenorphine and methadone programs in LMIC. Retention was measured for participants by length of follow-up, type of MAT and treatment dosage. Results: There were 58 MAT program studies, with 27047 participants eligible for inclusion in the review. Overall average retention after 12 months was 54.3% [95% confidence interval (CI)=46.2, 63.7%]. Overall average retention was moderately good for both buprenorphine (48.3%, 95% CI=22.1, 74.6%) and methadone (56.6%, 95% CI=45.9%, 67.3%) after 12 months of treatment. Among programs using methadone there was no statistically significant difference in average retention by dosage level, and the 10 highest and lowest dosage programs obtained similar average retention levels after 12 months. Conclusion: Medication-assisted treatment programs in low- and middle-income countries achieve an average 50% retention rate after 12 months, with wide variation across programs but little difference between those using buprenorphine versus methadone.
AB - Background and aims: Medication-assisted treatment (MAT) is a key component in overdose prevention, reducing illicit opiate use and risk of blood-borne virus infection. By retaining participants in MAT programs for longer periods of time, more noticeable and permanent changes in drug use, risk behavior and quality of life can be achieved. Many studies have documented retention in MAT programs in high-income countries, using a 50% average 12-month follow-up retention rate as a marker for a successful MAT program. This study contributes to a systematic understanding of how successful programs have been in retaining participants in low- and middle-income countries (LMIC) over time. Methods: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic literature search to identify MAT program studies that documented changes in retention over time for participants in buprenorphine and methadone programs in LMIC. Retention was measured for participants by length of follow-up, type of MAT and treatment dosage. Results: There were 58 MAT program studies, with 27047 participants eligible for inclusion in the review. Overall average retention after 12 months was 54.3% [95% confidence interval (CI)=46.2, 63.7%]. Overall average retention was moderately good for both buprenorphine (48.3%, 95% CI=22.1, 74.6%) and methadone (56.6%, 95% CI=45.9%, 67.3%) after 12 months of treatment. Among programs using methadone there was no statistically significant difference in average retention by dosage level, and the 10 highest and lowest dosage programs obtained similar average retention levels after 12 months. Conclusion: Medication-assisted treatment programs in low- and middle-income countries achieve an average 50% retention rate after 12 months, with wide variation across programs but little difference between those using buprenorphine versus methadone.
KW - Buprenorphine
KW - Developing countries
KW - Low- and middle-income countries
KW - Methadone
KW - Opiate abuse
KW - Opiate substitution programs
UR - http://www.scopus.com/inward/record.url?scp=84890195884&partnerID=8YFLogxK
U2 - 10.1111/add.12303
DO - 10.1111/add.12303
M3 - Review article
C2 - 23859638
AN - SCOPUS:84890195884
SN - 0965-2140
VL - 109
SP - 20
EP - 32
JO - Addiction
JF - Addiction
IS - 1
ER -