Research paper
Improvements in health-related quality of life among methadone maintenance clients in Dar es Salaam, Tanzania

https://doi.org/10.1016/j.drugpo.2016.03.005Get rights and content

Abstract

Background

Injection of heroin has become widespread in Dar es Salaam, Tanzania and is spreading throughout the country. To prevent potential bridging of HIV epidemics, the Tanzanian government established a methadone maintenance treatment (MMT) clinic in February 2011. We assess the effect of MMT on health-related quality of life (HRQOL) and examine factors, particularly HIV infection and methadone dose, associated with changes in HRQOL.

Methods

This study utilized routine data on clients enrolling in methadone from February 2011 to April 2012 at Muhimbili National Hospital. Change in physical (PCS) and mental health (MCS) composite scores, as measured by the SF-12 tool, were the primary outcomes. Backward stepwise linear regression, with a criterion of p < 0.2 was used to identify baseline exposure variables for inclusion in multivariable models, while adjusting for baseline scores.

Results

A total of 288 MMT clients received baseline and follow-up assessments. Mean methadone dose administered was 45 mg (SD ± 25) and 76 (27%) were confirmed HIV-positive. Significant improvements were observed in PCS and MCS, with mean increases of 15.7 and 3.3, respectively. In multivariable models, clients who had previous poly-substance use with cocaine [p = 0.040] had a significantly higher mean change in PCS. Clients who were living with HIV [p = 0.002]; satisfied with current marital situation [p = 0.045]; had a history of suicidal thoughts [p = 0.021]; and previously experienced cognitive difficulties [p = 0.012] had significantly lower mean change in PCS. Clients with shorter history of heroin use [p = 0.012] and who received higher methadone doses [p = 0.028] had significantly higher mean change in MCS, compared to their counterparts.

Conclusion

Aspects of mental and physical health, risk behaviors and quality of life among drug users are intertwined and complex. Our research revealed positive short-term effects of MMT on HRQOL and highlights the importance of sustained retention for optimal benefits. Comprehensive supportive services in addition to provision of methadone are needed to address the complex health needs of people who inject drugs.

Section snippets

Background

During the mid-1980s, East Africa became an important drug transit stop, introducing heroin in the region. As a consequence, the region also became a point of consumption, with an estimated 533,000 opiate users in East Africa (UNODC, 2011). Since the late 1990s, the injection of heroin has become widespread in Dar es Salaam, Tanzania and is spreading throughout the country (McCurdy et al., 2005, Ross et al., 2008, UNODC, 2011). The injection of heroin and other illicit substances contributes to

Study setting

In February 2011, the Tanzania AIDS Prevention Project launched the first MMT clinic in Tanzania, offering methadone, at Muhimbili National Hospital in Dar es Salaam. The establishment of methadone services was supported by the Tanzanian government – namely, the Ministry of Health and Social Welfare and Drug Control Commission – as well as the U.S. Centers for Disease Control and Prevention (CDC), Muhimbili University of Health and Allied Sciences, and Pangaea Global AIDS (Pangaea). The

Ethical considerations

Ethical clearance was granted by Muhimbili University of Health and Allied Sciences (MUHAS) Research and Publication Committee in Dar es Salaam, Tanzania. The use and analysis of de-identified, programmatic data was also approved by the U.S. Centers for Disease Control and Prevention, E&I Review Services in the United States as program evaluation and non-human subjects research.

MMT clients

A total of 288 MMT clients were included in this study. Baseline characteristics of enrolled patients are presented in Table 1. Overall, 260 (90%) were male; 162 (56%) had primary education or lower; 93 (32%) had children; 36 (13%) were married, and 238 (83%) were unemployed. Median length of heroin use was 10 years (IQR: 6, 15) and 5 (2%), 65 (22%) and 39 (14%) reported poly-substance use with cocaine, alcohol, benzodiazepine, respectively.

Improvements in HRQOL

At baseline, mean overall Physical and Mental Health

Discussion

Utilizing data from the first publicly funded methadone clinic on the mainland of Sub-Saharan Africa, this study compared HRQOL among PWID prior to and three to six months after MMT initiation and examined factors associated with changes in HRQOL. Consistent with research documenting the impact of MMT on quality of life (Feelemyer et al., 2013), we observed significant short-term improvements in HRQOL, on average, in the first cohort of opioid addicts receiving MMT in Tanzania. Longer duration

Funding

This work was supported by the President's Emergency Plan for AIDS Relief (PEPFAR) through Centers for Disease Control and Prevention under the terms of [Grant number 5U2GPS000951], the National Institutes of Health, National Institute on Drug Abuse (Grant No. 1R34DA037787), and in part from research supported by the Baylor-UT Health Center for AIDS Research (CFAR), an NIH funded program [AI036211].

Acknowledgements

We would like to thank the clients, providers and program managers of the methadone clinic at Muhimbili National Hospital.
Conflict of interest: We declare that we have no conflicts of interest.

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