Prevention of HIV
Among Heroin Users with
Methadone Maintenance Treatment :                           The Hong Kong Experience

Char-Nie CHEN

Hong Kong Advisory Council on AIDS

Hong Kong Association of Addiction Psychiatry

 

 

Historical Backgroud of Methadone Treatment Programmes (MTP) in HK

l   1970 : The use of methadone as residential detoxification agent in SARDA by Dr. James Ch’ien

l   1972 : 2 maintenance clinics (Wanchai & Kowloon) set up by Dr. L.K. Ding

l   1974-75 : Dr. Robert Newman’s Report on methadone treatment clinic in Hong Kong

l   1976 : A detoxification clinic in Wanchai district

l   1977 : 20 detoxification clinics in Hong Kong

l   1978-79 : 20 maintenance & detoxification clinics

l   1999-2000 : A formal review of methadone clinic

 

Aims of MTP

n    To provide a readily accessible, legal, medically safe & effective alternative to opiate use

n    To keep in touch constantly, & provide necessary public education

n    To reduce crime & antisocial behaviour due to illicit drug use

n    To enable drug users lead a normal productive and family life

n    To reduce intravenous drug use & needle-      sharing, thereby preventing the spread of diseases, e.g., AIDS, hepatitis B & tetanus

n    To assist drug abusers to detoxify & achieve a drug-free state

Admission Criteria of MTP

l   An open-door policy, irrespective of sex,  age, ethnic origin, religion, or nationality

l   No waiting list

l   Parental consent for the under 18s

l   Those under 21 with less than 2-year history of abuse are encouraged to attend for residential treatment

l   Those with medical diseases are referred for specialist treatment

l   An initial dosage of of not exceeding 30 mg

 

Admission Procedure for MTP

n   Detailed medical & drug history

n   General physical examination

n   A urine sample for opiates

n   A voluntary blood check for HIV, hepatitis,       syphilis, etc.

n   Discussion on detoxification or maintenance

n   A dose of methadone prescribed according to history, & adjusted accordingly

n   Health & risk education by doctor

n   Counselling by social workers

Use of Methadone Linctus

u  Under strict control & no take-home drug

u  Only a single daily dose is given in liquid       form

u  Must be taken in front of the staff

u  After medication, a yeast tablet & a cup   of water are also given to swallow     through

u  Methadone Treatment Card is collected & returned only after methadone is   clearly swallowed

Counselling

l   Provided by SWs

l   Targets: Mainly for new clients;                      only on request or otherwise for those readmitted & >21s  

l   Flexible time-table & place

l   Regular case meetings with MOs

l   Professional counselling service is conducted according to the Working Guidelines for Social Workers & Supervisors on the Provision of Social Services to Methadone Patients (revised 1995)

Staff of MTP

n   Auxiliary Medical  Services members      

     (P/T payment)                                135

n   Senior Medical officers (F/T)                         3

n   Medical officers on roster basis (Free)    43

n   Social workers *                                                                from the SARDA (NGO) (Paid as                                                government subvention to SARDA)         21

Cost of MTP 1999

l   Dept of Health                     $33m

l   SARDA                                  $  9m

l   Total expenditure                  $42m

l   Total attendance in 1999          2,460,316

l   Cost per person-attendance               $17                              

Comparative Cost of MTP with Other Institutional Cost 1999

l   DATCs                                $227,895

l   SARDA    (NGO)                       $  12,751

l   Caritas    (NGO)                     $  23,812

l   Religious NGOs                      $  58,381

l   HWH of SARDA                  $  41,233

l   PS-33 (NGO)                            $  52,381

l   MTP (DOH)                         $         17             

Hong Kong Methadone Programme Attendances at all clinics (DOH, HK, 2000-2001)

      Year                 No. of Attendance

l     1989                         2,630,490

l     1990                         2,977,490

l     1991                         2,932,679

l     1992                         2,694,027

l     1993                         2,364,330

l     1994                         2,336,371

l     1995                         2,555,812

l     1996                         2,619,302

l     1997                         2,523,485

l     1998                         2,442,205

l     1999                         2,460,316

l     2000                      2,379,744

l     2001                         2,384,780   

l     2002                         2,592,028

l     2003                         2,575,322

l     2004                         2,478,512

No. Registered at End of Year

               10,045

               10,951

               10,985

                 9,418

                 8,976

               10,401

               10,006

               10,394

                 9,756

                 9,590

                 9,695

                 9,176

                 9,233 

               10,127

                 9,613

                 9,264 

Methadone Treatment Programme in HK 1999

l    New admissions                     1,028

l   Re-admissions                 8,358

l   Effective registration                 9,695     as at 31.12.1999

(Men=92%; Women=8%)

l   Total attendance                       2,460,316

l   Average daily attendance         6,741

l   Average daily attendance rate                            of registered patients                      69.5%  

                                      

Methadone Detoxification 1999

l Detoxified                 101 (1   %)

l In the programme       156 (1.6%)

l In 18-month aftercare 96 (1   %)

l Total                   353 (3.6%)                       

Institutional Clientele

Age in Treatment Programmes (1998)

Time Since First Registered to MTP 1998

3-year Double-blind Study of Methadone & Placebo Maintenance Treatment of Narcotic Addicts in HK
(Newman & Whitehill, Lancet, Sep 8, 485-488, 1979)

                  Stay in Rx      Re-Use of Heroin

                     Yes            No             Yes              No

 

Treatment gr.   28   22      8    14

 

Control gr.      1   49      31    18

 

Odds Ratio     62.36            0.33

95% CI        7.97-487.9  0.12-0.94

Newly-Reported Abusers 1976-2003 Heroin By Sex (Source: CRDA, HK)

Previously-reported Abusers 1976-2003        Heroin By Sex (Source: CRDA, HK)

Newly-reported Abusers 1976-2003        Method of Taking Heroin (Source: CRDA, HK)

MTP in Hong Kong               is                                                   a large-scale, low-cost, easily accessible, harm-reduction & pragmatic approach             to drug abuse

Accidentally, MTP’s new task since 80s is to reduce IDUs, especially sharing of needles, and reduce the transmission of HIV

Recent HIV Risk Behaviour & Adherence to MTP in HK
(Wong, KH et al, J Subst Abuse Treat, 24: 233-239, 2003)

                   Drug Use/Past 4 wk   Inject Drug/Past 30 d   >5 Inject in past wk

Methadone             (N = 672)                     (N = 346)                         (N = 344)

     Dosage             Yes            No                 Yes            No          Yes     No

< 60 mg  262     107     118           53      72        97

> 60 mg  211     92     108        67      47      128

 

Odds Ratio         1.07              1.38                2.02

95% CI   0.76- 1.51           0.86- 2.21               1.25 – 3.26

 

p value        0.7 (ns)                0.15 (ns)       < 0.002

Recent HIV Risk Behaviour & Adherence to MTP in HK
(Wong, KH et al, J Subst Abuse Treat, 24: 233-239, 2003)

Methadone      Drug Use/Past 4 wk   Inject Drug/Past 30 d   >5 Inject in past wk

Attendance          (N = 672)                  (N = 346)                         (N = 344)

In Past Week         Yes          No                 Yes            No          Yes     No

< 2 times 91       10       47       12      41        18

> 2 times 382   189     179      108      78      207

 

Odds Ratio         4.5          2.36                6.04

95% CI   2.21- 9.42           1.15 - 4.94        3.15 – 11.69

 

p value     < 0.001               < 0.01               < 0.001

Sharing Syringes in Past 4 Wks (N=305)

The total no. of HIV cases by exposure categories at end of March 2006 (N=2,914)

Cumulative HIV(+) Cases Reported By           Exposure Category 1984-March 2006* (N=2,914)

Cumulative AIDS Cases Reported By       Exposure Category 1984-March 2006* (N=799)

 

 

HIV sero-prevalence from
universal testing programme

Knowledge of Disease Contacted From Syringe-sharing

 

Malaysian Delegation to HK
(December 15-17, 2005)

l   Dato’ Dr. Chua Soi Lek (Minister of Health)

l   Ms. Gaye Phillips (UNICEF Country Representative)

l   Dato’ Tan Chin Meng (Member of Executive Council, Malaysian Government)

l   Dr. Teng Seng Chong (Advisor to the Minister, MOH)

l   Dr. Sunoor Verma (Senior Advisor, UNICEF)

l   Dr. Rushidi Ramly (Deputy Head, CDC, Department of Public Health, MOH)

l   Dr. Christopher Lee Kwok Choong (Consultant Physician, Department of Infectious Diseases, Kuala Lumpur Hospital)

l   Mr. Yap Soo Kian (Press Secretary, MOH)

l   Dr. Noorliza Noordin (Head, Economic & Health Finance Department, Institute of Health Management Research, Kuala Lumpur)

Experts of AIDS from China
(January 11-15, 2006)

l  Mr. HAO Yang 郝陽 (Duputy Head, CDC, MOH)

l  Mr. YU Shi Li 于世利 (衛生部規劃財務司處長)

l  Mr. HAN Meng Jie 韓孟傑 (疾病控制中心愛滋病控制中心副主任)

l  Ms. YU Dong Bao 余冬保 (愛滋病控制中心政策研究室副主任)

l  Ms. PONG Ling 龐玲 (愛滋病控制中心健康教育與行為干預室研究員)