WHO collaborative project on drug dependence treatment and HIV/AIDS
Workshop Beijing 29.-31.05.2006

 

  Methadone maintenance treatment and prevention / care of blood born infections

 

•             Uchtenhagen

Research Institute for Public Health and Addiction

associated with Zurich University

 Overview

•             Prevention and management of blood born infectious diseases

 

•             Potential role of MMT for prevention and management of BBI

 

•             Conditions for effective treatment

 

•             Effects of MMT on risk behaviour and seroconversions

  Prevention measures for blood born infectious disease

 

•      Safer use interventions

•      Safer sex interventions

•      Routine testing for blood-born infections (BBI)

•      Vaccination for Hep B

•      Risk awareness assessment

•      Risk awareness training

•      Involvement of clientes partners and family

Management of blood-born infectious disease (1)

•      Assessment and testing (HIV, Hepatitis)

•      Assessment of client motivation, motivational enhancement for treatment compliance

•      Antiretroviral Therapy (ART)

–Substances used (NRTI, NNRTI, PI)

–Choice of medication, resistance testing

–Management of asymptomatic seropositive clients

–Management of acute retroviral syndrome

–Management of symptomatic HIV infections

Management of blood-born infectious disease (2)

•      Anti-retroviral medication (contd.)

–monitoring (clinical, CD4-count, virus load)

–side-effects

–interactions with substitution drugs

–interactions with other medications

–interactions with illegal and nonprescribed drugs

•      Medical care

•      Psychiatric care

•      Psychosocial care

Conditions for managing
blood born infectious disease

 

•      Availability of infrastructure

•      Availability of infection specialists

•      Availability of ART

•      Treatment protocol for clients with BBI

•      Involvement of health care and social services

•      Involvement of partners / family

Role of MMT for HIV infected IVDU

•      Reduction of illicit i.v. use = reduction of risks for blood born infectious disease

•      Stabilisation of physical and psychological health improves chances for adhering to anti-retroviral therapy HART

•      Stabilisation of living conditions reduces risks for dropping-out

•      Regular and continuous contact with staff helps to overcome crisis situations

Factors facilitating good outcome of Methadone maintenance
 

•      Client-friendly atmosphere

•      Individualised treatment regimes

•      Retention over min. 6-12 mths

•      Good quality ancillary services

•      Flexible dosage policy

•      Minimising medication side-effects

•      Average dosages >60 mg/day

•      Flexible control policy

 

 

Obstacles to good outcome of Methadone maintenance

 

•      Long waiting lists

•      High administrative thresholds

•      Inadequate costs

•      Hostile, defensive staff attitudes

•      High level of staff burn-out

•      Rigid dosage and control regimes

•      Administrative limitation of treatment duration

Effects of MMT on risk behaviour and seroconversion

•Risk reduction effectiveness

–Less risk behaviour, less needle sharing (Marsch 1998)

–Reduced number of injections (Caplehorn & Ross 1995)

–Significantly reduced incidence of seroconversions (Novick et al 1990, Moss et al 1994)

–Persisting effects after termination of treatment (Camacho et al 1997)

•How to improve risk reduction effectiveness

–By improving retention and compliance with            treatment (Darke 1992, Wugalter & Anglin 1997)

Changes in risk behaviour
during Methadone maintenance with CBT
(Schroeder et al 2006)

Seroconversion during MMT :
% HIV seropositivity (Metzger et al 1993)