Does a take-home dose program result in better patient adherence to methadone? Evidence from Vietnam

Methadone maintenance treatment (MMT) is an effective treatment for opioid use disorders, yet patient adherence and retention remain challenges in many countries. To address this, Vietnam piloted a take-home methadone program in 21 clinics across three northern provinces.

Using a stepped-wedge design, the study evaluated the impact of this take-home program on treatment adherence among 500 MMT patients who were eligible for take-home methadone in 12 pilot clinics. We used T-tests and Poisson regression models to compare patients' treatment adherence between take-home and in-person dosing periods, and conducted sensitivity analyses to assess the robustness of the results.

The results indicated a significant improvement in adherence during take-home months. Joining the take-home program is associated with a reduction in methadone doses missed in a month by approximately 60%. Each additional month in the program is associated with a further 11% decrease in missed doses. Sensitivity analysis supports this finding. Each additional month in the program is also associated with a reduction in the number of times missing five consecutive doses in a month by 12.3%, but no association was found between take-home and the outcome. The sensitivity analysis found a significant negative association between the likelihood of missing five consecutive doses and the patient's continued participation in the take-home program until the last month of data collection.

The findings underscore the effectiveness of the take-home methadone policy in enhancing patient adherence, with greater benefits observed over extended participation.