[Current situation related to antiretroviral therapy and related influential factors on HIV infected injection drug users in the methadone maintenance treatment clinics].

OBJECTIVE: To find out the current coverage of antiretroviral therapy (ART) among HIV positive subjects and to identify the major influential factors associated with the participation in ART among them. METHODS: 291 HIV positive subjects from 6 methadone maintenance treatment (MMT) clinics in Guangxi and Yunnan province were surveyed by questionnaires. RESULTS: 217 males (74.6%) and 74 females (25.4%) were under investigation, with the average age of 38.4 +/- 5.9. Most of them received less than senior high school education, married and unemployed. Results from the single factor logistic regression analysis showed that: working status, living alone, self-reported history of drinking alcohol in the last month, negative attitude towards MMT among family members,poor self-reported compliance to MMT in the last month,lack of incentives in the MMT clinics, reluctance on disclosure of their own HIV status, good self-perception on their health status, lack of communication on ART related topics among family members in the last 6 months, lack of correct attitude and knowledge on ART etc. appeared as the main factors that influencing the participation in ART program among the patients. Data from the multivariate logistic regression analysis showed that factors as: living alone, unwilling to tell others about the status of HIV infection, poor self-perception on HIV infection, lack of discussion of ART related topics within family members in the last 6 months and poor awareness towards ART among the family members etc., were associated with the low participation rate of ART. Conclusion Strengthening the publicity and education programs on HIV positive patients and their family members at the MMT clinics seemed to be effective in extending the ART coverage. Attention should also be paid to increase the family support to the patients.

[Factors associated with overdose-caused mortality of HIV-positive patients who were on methadone maintenance treatment program].

OBJECTIVE: To study the factors that associated with the mortality of overdose on methadone maintenance treatment(MMT)among HIV-positive patients. METHODS: A 1 : 1 matched case-control design was used to identify the relationship between factors related to demography, drug use, characteristics of treatment and the mortality of overdose. 110 HIV-positive patients who died of drug overdose from March 2004 to September 2012 were defined as cases. Controls were another 110 patients who were still alive and paired with the cases, according to the same gender, similar date of MMT initiation and from the same clinics. RESULTS: Multivariate conditional logistic regression analyses indicated that risk factors as sharing needles before enrolled in the MMT program(OR = 5.19, 95% CI:1.39-19.33), HIV infection because of injecting drug-use (OR = 3.08, 95% CI: 1.16-8.21), and off from the treatment before the end point of the program(OR = 2.54, 95% CI: 1.23-5.23)were associated with mortality caused by overdose. Higher adherence(OR = 0.31, 95%CI: 0.10-0.95)appeared to be associated with lower mortality when compared with the control group. CONCLUSION: In order to reduce the mortality rate, comprehensive intervention could be introduced to improve the compliance of retention on MMT among patients. Intervention efforts should be focused on those patients who shared needle/syringes.

[Effect of intermittent irrigation in paddy fields on mosquito control].

OBJECTIVE: To investigate the effects of intermittent irrigation in paddy fields on mosquito control and the impact on growth and yield of rice. METHODS: The paddy fields were divided into an experimental group and a control group. In the same context of other measures, the experimental group was performed with intermittent irrigation and the control group with conventional irrigation. The densities of larvae of Anopheles sinensis and Culex tritaeniorhynchus were surveyed by the suction trapping method. The plant traits, leaf age process, tiller dynamics, yield structure and actual rice production were observed. RESULTS: Compared with the control group, the average densities of larvae of Anopheles sinensis and Culex tritaeniorhynchus were reduced of 10.32/m2 and 13.93/m2 respectively in the experimental group, the control rates were 79.84% and 72.14% respectively, the average yield increased of 22.5 kg/667 m2, water conservation was 187.4 m3/667 m2, and the increased revenue was 75.78 yuan/667 m2. CONCLUSIONS: The intermittent irrigation in paddy fields not only can control mosquito larva breeding effectively, but also save water and electricity, and increase the harvest.

[Evaluation on the long-term effectiveness among the first set eight methadone maintenance treatment clinics in China].

OBJECTIVE: To evaluate the long-term effectiveness of the first set 8 methadone maintenance treatment (MMT) clinics in China. METHODS: Repeated cross-sectional surveys were conducted on the first month after the enrollment and 5 years later, among drug users who received MMT, using a standard questionnaire. Data on demographic characteristics, HIV-related high-risk behaviors, criminal records associated with drug use and related family/social functions were collected and analyzed. RESULTS: There were 252 and 195 participants being interviewed at the baseline and the 5-year surveys, respectively. Of them, 66 participants were involved in both surveys. There was no significant differences on factors as ethnicity, level of education, working status, marital status and living status (P > 0.05) between the baseline and the 5-year surveys. Compared with data from the baseline survey, participants' behavior on drug abuse (100.0% vs. 24.1%, P < 0.001), needle sharing behavior (19.4% vs. 0.0%, P < 0.001), and exchanging sex for drugs (34.5% vs. 0.0%, P < 0.001) had significant decreases at the 5-year survey. Rates on condom use (10.6% vs. 25.0%, P = 0.004), and having jobs (27.8% vs. 47.7%, P < 0.001) had been improved significantly, while self-reported criminal cases related to drug use (15.1% vs. 1.5%, P < 0.001) and the contacts with drug users (88.9% vs. 31.3%, P < 0.001) had been significantly reduced after joining the MMT program. CONCLUSION: MMT could play an active role in reducing the HIV-related high-risk behaviors, criminal cases associated with drug abuse as well as enhancing the family and social functions of the MMT patients. Providing high quality service to the MMT clinic and trying to keep the drug users stick to the program remain difficult. It was also important to improve the training programs for staff working at the MMT clinics.

[Characteristics and associated factors of long-term retention for methadone maintenance treatment patients].

OBJECTIVE: To describe the characteristics and factors associated with long-term retention for methadone maintenance treatment (MMT) patients. METHODS: This study was conducted in eight MMT clinics located in Sichuan, Yunnan, Guangxi, Guizhou and Zhejiang provinces. Five hundred and thirty-nine MMT patients who enrolled in MMT clinics in 2004 and retained in treatment by June 2010 were selected as study subjects. Chi-square tests were used to compare the demographics and drug abuse history at enrollment and treatment characteristics during the follow-up period between continuous treatment patients and discontinuous treatment patients. RESULTS: Of the 539 patients, 110 (20.4%) were continuous treatment patients whereas 429 (79.6%) were discontinuous treatment patients. Of these 429 discontinuous treatment patients, 84.1% (361/429) had 2-4 treatment episodes whereas 15.9% (68/429) had 5 or more episodes during follow-up period. When continuous treatment patients were compared with discontinuous treatment patients, living with family members or friends (88.2% (97/110), 78.5% (337/429)), age of first drug use under 25 (61.8% (68/110), 71.3% (306/429)), low urine morphine positive test results (67.3% (74/110), 38.2% (164/429)) and living within 5 kilometers of the MMT clinic (72.7% (80/110), 61.3% (263/429)) were positively associated with higher possibility of continuous treat retention (P < 0.05). Demographics and drug abuse characteristics at enrollment, including gender, age, employment status, family relationship, injection, needle sharing, criminal behavior, contacts with drug users, MMT daily dosage and family members receiving MMT were not significantly associated with treatment retention (P > 0.05). CONCLUSION: Illicit drug use during the treatment and longer distance travelling to MMT clinic might have negative impact on patients' continuous treatment retention. Mobile MMT vehicles and expanded MMT service sites could be introduced to improve compliance of treatment retention of MMT patients.

[Health education needs for malaria control in rural residents in Hai'an County].

OBJECTIVE: To understand the status of knowledge, attitudes and practices (KAP) and health education needs for malaria prevention and treatment of rural residents in Hai'an County. METHODS: Hai'an County was divided into three regions of east, south and north, and the primary and secondary students and residents were selected with the multi-stage sampling method and investigated with questionnaire for the status of KAP and the health education needs of malaria control. The results were analyzed statistically. RESULTS: The awareness rates of malaria transmission, symptoms, prevention knowledge in the residents were significantly higher than those in the students (P < 0.05). The awareness rates of malaria prevention knowledge in the residents had significant differences among the residents with different education levels (P < 0.05), and the education levels were positively correlated with the awareness rates of malaria prevention knowledge. The main ways of rural residents to get their knowledge of malaria control were radio, newspapers, the village doctors, public health bulletin, posters, students, and television caption in order; the main ways of students to get their knowledge of malaria control were television, newspapers, public health bulletin, teachers, radio, and flyers in order. CONCLUSIONS: We should pay full attention to the advantages of mass media to carry out the extensive health education on malaria prevention and control, and should also take into account the different characteristics of the audience.

[Risk factors which were associated with heroin use during the methadone maintenance treatment among 1301 patients in 9 cities of China.].

OBJECTIVE: To determine the proportion of heroin use among patients who were involved in community-based methadone maintenance treatment (MMT) program and to identify the risk factors associated with heroin use. METHODS: This study was conducted in 9 MMT clinics within 3 provinces. Thirteen hundred and one patients who met the study criteria were selected from each of the five groups with different dosages of methadone users. An administrative questionnaire was applied to explore the demographics, drug abuse-related behaviors and MMT services received by the clients, etc. The prevalence of depression and anxiety among the clients were also collected by SAS and SDS. Urine samples were collected as a biological marker to indicate if heroin had been used. RESULTS: Of the 1301 patients, 76.2% were males. The mean age was (34.6 +/- 6.5) years while 71.7% had an education level of primary school or below. The average daily dosage of methadone was (48.1 +/- 29.4) mg and self-satisfied evaluation score on treatment was 8.6. On average, 27.7% urine samples showed positive opiate evidence. Marital status, employment status, treatment retention, self-satisfied evaluation score on dosage and dropout history were found to be significantly associated with heroin use, while gender, education level and dosage had no significant association with heroin use. It seemed that risk factors that associated with heroin use were different from areas to areas. CONCLUSION: High quality MMT clinic services, high self-satisfied score, longer treatment retention and low dropout rate seemed to have the effects of reducing the risk of ongoing heroin abuse under the methadone maintenance treatment program.

[A study of HIV/AIDS-related stigma and discrimination among former plasma donors in rural areas].

OBJECTIVE: To understand the types of, reasons for and sources of stigma and discrimination in a rural community where the majority of people living with HIV/AIDS (PLHA) are former plasma donors (FPDs). METHODS: Eighty local residents, including 20 HIV-positive villagers, 20 family members, 20 villagers from non-HIV-positive households and 20 health workers, were selected as study subjects by using purposive sampling method in rural areas of Anhui Province. Face-to-face interviews and focus group discussions were held to collect information on HIV/AIDS-related stigma and discrimination and its contributing factors. RESULTS: Of the 80 study subjects, 1 didn't finish the survey. Of the 79 subjects who finished the survey, the main forms of stigma and discrimination were expanded stigma [81.0% (64/79)], abandonment and avoidance, stigma and discrimination in healthcare setting [47.4% (28/59)], loss of social support [33.3% (13/39)]. The level of stigma was less in village where were more HIV-positive villagers living and vice versa. The reasons for stigma and discrimination included: ignorance or misunderstanding of HIV/AIDS [57.5% (23/40)], fear of HIV/AIDS [32.5% (13/40)] and morality judgment toward PLHA. The majority of HIV positive participants were unwilling to disclose their positive status to others in order to protect their family members and children. CONCLUSION: Ignorance and misunderstanding of HIV/AIDS were main contributing factors to HIV/AIDS-related stigma and discrimination and it is very important to implement appropriate intervention programs to reduce stigma and discrimination.