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Predictors of outcome in methadone programs: effect of HIV counseling and testing
T A Farley1, M L Cartter, J T Wassell
1Division of Field Services, Centers for Disease Control, Atlanta, Georgia.
Objective:
To identify predictors of treatment outcomes in methadone maintenance programs and to determine whether HIV counseling and testing influenced these outcomes.
Design:
Retrospective record review.
Setting:
Four methadone maintenance programs in four cities in Connecticut, USA.
Participants:
Five hundred and ninety-four clients, who began treatment over an 18-month period and for whom records were available, took part.
Interventions:
HIV counseling and testing.
Main Outcome Measures:
Risk of treatment discontinuation and persistent in-treatment illicit drug use.
Results:
The most important predictor of treatment discontinuation and of persistent in-treatment illicit drug use was self-reported pretreatment cocaine use. After controlling for this and demographic risk factors, clients who received initial HIV counseling, when compared with clients who did not, had a similar 12-month discontinuation risk (54% vs 59%; P = 0.08) but were less likely to show persistent illicit drug use (46% vs 53%; P = 0.01). Among counseled entrants who were tested for HIV antibodies, those receiving positive results had a 12-month discontinuation risk similar to those receiving negative results (50% vs 52%), but more often showed persistent illicit drug use (57% vs 44%), although this difference may have been due to chance (P = 0.28). The majority of clients who discontinued treatment did so because they were discharged for noncompliance with clinic rules, usually for failing to pay fees.
Conclusions:
HIV counseling and testing do not have a substantial adverse effect on methadone treatment outcomes. In the clinics under study, failure to pay clinic fees was an important factor contributing to discontinuation of treatment.