VsNG NGHIEN CUfU KHOA HOC
THUC TRANG SlT DUNG MA TUY VA MOT SO YEU TO LIEN QUAN 6 BENH NHAN DIEU TW METHADONE TAI TRUNG TAM Y TE HUYEN DONG ANH, HA NOI NAM 2018
TOM T A T
Muc tieu ciia nghien ciiu la md ta thuc trang va xac dinh mgt s6 y^u t6 hen quan din viec sii dyng ma tiiy d benh nhan di^u tri Methadone tai Trung tam y ti huyen Dong Anh, Ha Ngi nam 2018. Nghien ciiu dugc thiet kS cat ngang mo ta, phong van 155 ddi tugng dang dieu tri Methadone tai cac co so dieu tri ciia huyen Dong Anh, Ha Ngi. K^t qua cho th4y: (1) Ty le d6i tugng nghien ciiu su dung ma tuy noi chung trong dieu tri Methadone t^i cac CO sd diiu tri ciia huyen Dong Anh la 29,0%), ty le sii dung heroin, ma tiiy da va cac loai ma tiiy khac Ian lugt la 21,9%; 12,3% va 3,2% (2). Co m6i lien quan co y nghia thSng ke giiia tinh trang viec lam, tudi ian dau sii dung ma tuy, thdi gian sir dung ma tiiy trude dieu tri Methadone, viSc man thii dieu tri, co ngudi than/ban be/
ban tinh dang sir dung ma tiiy, su phii hop ve thdi gian boat dgng cua co sd, thai do cua can bg y te tai co sd vdi tinh trang tai sir dung ma tiiy ciia cac doi tugng. Khuyen nghi bao gdm tang cudng cac boat dgng tu van dieu trj, bd sung test nhanh phat hien ma tuy tong hgp tai co sd diiu tri va sjp xip thdi gian boat dgng ciia co sd cho phii hgp vdi nhu cau ciia ddi tugng.
Tfr khoa: Sii dung ma tiiy. Methadone, dieu tri.
SUMMARY
THE CURRENT SITUATION OF DRUG USE OF PATIENTS TREATED WITH METHADONE MAINTENANCE THERAPY AT DONG ANH DISTRICT HEALTH CENTER, HANOI IN 2018 AND SOME RELATED FACTORS
The objective of study was to describe the current situation and to identify some factors related to drag use of patients treated with Methadone Mamtenace Therapy (MMT) at Dong Anh District Health Center, Hanoi in 2018. A cross - sectional descriptive smdy was conducted
Nguyen Thi H g u \ Nguyen Hen Cuting\ Do Mai Hoa>
to interview 155 respondents treated in there. The results show that: (1) The percentage of respondent to use drugs in MMT treatment was 29,0%o, the percentage of using heroin, Methamphetamine and others were 21,9%; 12,3%
and 3,2%), respectively. (2) Some factors related to dmg use of patients treated with Methadone Maintenance Therapy were employment situation, age of first time of drug use, duration of drag use before MMT, adherence to treatment, relatives/friends/sex partners using drugs, suitability of treatment facility's operation time and attitude of health staffs. Recommendations include: To strengthen treatment counselling; To add more rapid drag test at treatment facilities; To arrange treatment facility's operation time.
Keywords: Drag use. Methadone, treatment I. O^T V A N DE
Diiu tri nghien cac chSt dang thudc phien bang Methadone (MMT) da dugc chung minh cd hi?u qua trong viec diiu tri nghien, giiip lam giam tin suat va tien tm ngung sir dung cac ch4t gay nghien, giam nguy co va d^
phong lay nhiSm HIV/AIDS trong nhom nghien chich ma tiiy. Tuy nhien, hien nay xay ra tinh trang benh nhan khong man thii dieu tri, bo dieu tri, tai nghien, tai su dung ma tiiy, hoac chuyen sang sir dung cac dang ma tiiy khac. Vi vay, nghien ciiu nay dugc tien hanh vdi muc tieu mo ta thuc trang va xac dinh mgt so yeu to lien quan den viec sii dung ma tuy d benh nhan dieu tri Methadone tai Trung tto y te huyenDdng Anh, HaN9inam2018.
II. DOI TirONG VA PHU'ONG PHAP NGHIEN Ciru
Doi tirong nghien cihi: Benh nhan cd ho so b?nh an dang dieu tri Methadone tir 3 thang trd len d giai doan duy tri heu va on dinh lieu.
Thdi gian va dia diem nghien cmi: Tii thang 1. Trung tam Y te huyen Dong Anh, Ha Noi
2. Trirdng Dai h9C Y te Cong cdng
» Ngay nhan bai: 12/07/2018 | Ngay phan bien: 20/07/2018 | » Ngay duyet dang: 01/08/2018 S65(46)-Thaiig09-I0/2018 j ^ - . Website; yhoccongdong.vn I
JOURNAL OF COMMUKITY MEOICINE
Y H O C
CONG E)ONG 2018
10/2017 din thang 06/2018 tai huyen Dong Anh, Ha Ngi.
Thiet ke nghien ciru: Thiet ke nghien cim mo ta cat ngang, ket hgp dinh lugng va dinh tinh.
Co mau va chon mau: Chgn mau toan bg benh nhan va ho so benh an ciia benh nhan dang diiu tri Methadone dugc 3 thang trd len d giai doan duy tri. Tong cong cd 155 benh nhan kera theo benh an du tieu chuin va ddng y tham gia nghien ciiu.
Phuwng phap thu thap thong tin: Sii dung phieu hdi phdng van ban cau tnic.
Phutnig phap phSn tich s6 lilu: Su dung phan mem EpiData 3.0 di nhap lieu va phan mem SPSS de phan tich.
S6 heu dugc md ta tin so, ty le va phan tich mdi lien quan dimg ty sd chenh OR vdi khoang tin cay 95%o.
Dao diic ciia nghien ciiu: Nghien cim da dugc Hgi ddng khoa hgc va Hgi ddng dao due cua Tradng Dai hgc Y ti Cong cong thong qua va cho phep tien hanh nghien cim.
III. KET QUA N G H I £ N CUtJ 1. Thong tin chung ve doi tuong nghien ciru Bdng 1: Thdng tin chung vi ddi tu^g nghiin cuu
Dac diem Gioi tinh
Tuoi
Trinh do hoc van
Tinh trang hon nhan
Tinh trang viec lam
Noi a hien tai
Thu nhap trung binh/thang
Nam Duoi 30 tuoi 3 0 - 3 9 tu6i 40-49tu6i
> 50 m6i Duoi THPT Til THPT tro len Dii ket hon Chua ket hon/li di/goa Co viec lam That nghiep Huyen Dong Anh Huyen khac Khong CO thu nhap Duoi 3 tri^u dong Ttr 3 tneu dong tro len
Tan so 155
14 65 58 18 78 77 108 47 123
32 98 57 32 15 108
Tyle(%) 100,0
9,0 41,9 37,4 11,7 50,3 49,7 69,7 30,3 79,4 20,6 63,2 36,8 20,6 9,7 69,7 Trong sd 155 ddi tugng tham gia nghien ciiu deu la
nam gidi (100%), cd do tudi trung binh la 39,6 tudi (±8,3), phin Idn trong dg tudi tir 39 - 49 mdi (79,3%), chu yiu sdng tren dia ban huyen Ddng Anh (63,2%). Ty le ddi nrgng thit
nghiep la 20,6%o, Crinh do hgc van dudi THPT chiim 50,3%o va 30,3%o d6i tugng chua kit hon, ly di, ly than hoac gda. Thu nhap trang binh ciia cac doi tugng la 3,81 trieu ddng, trong do nhom CO thu nhap > 3 trieu dong la chii yeu (69,7%o).
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2. Th^rc trang tai sir dung ma tuy cua doi tu-ong nghien cihi
Bdng 2. Thuc trang su dung ma tuy trong 01 thdng qua cua doi tuOng nghien cuu
Dac diem Sir dung ma tuy trong 1 thang qua
Tiin suat sii dung ma tiiy trong 1 thang qua
Su dung ma tiiy trong 1 thang qua tlieo loai ma tiiy
Co Khong 1 lan/thang 2 - 3 ISn/thang Tit 4 lan/thang tro len Heroin
Ma tiiy da
Dang khac (thuoc lac, hong phign)
Tan so 45 110
14 23 8 34 19 5
Tylf(%) 29,0 71,0 31,1 51,1 17,8 21,9 12,3 3,2 Ty I? doi tugng con sir dung lai ma tuy trong qua tiiy khac nhu h6ng phiin, thudc lie (3,2%). Ty IS su dung trinh diiu tri Methadone la 29,0%. Trong do, ty le ddi cac loai ma tiiy nay cd chenh lech so vdi cac nghien ciru tugng sii dung 2 - 3 Ian trong thang qua chiim phan Idn khac trade do, do cac ySu td lien quan din thdi gian diiu (51,1%). Trong cac ddi tugng nghien ciiu, chii yiu sir tri Methadone cua doi tugng nghien ciiu, liiu dik trj dung la heroin (21,9%), ma tiiy da (12,3%), cac dang ma trang binh khac nhau.
Bieu do 1. Thuc trgng su dyng ma tuy da tru&c vd trong qua trinh diiu tri Methadone
Tinh trang sii dung heroin tir trade khi diiu tri la 100% da giam xu6ng con 21,9% tai thdi diim nghien ciiu. Dieu nay cho thay hieu qua ciia chuong trinh diiu tri Methadone trong viec giam su dung cac chit dang thuoc phien. Tuy nhien, tinh trang sir dung ma tuy da lai tang len so vdi trudc khi diiu tri, khi ty le d6i mgng sir dung ma hiy da tai thdi diem nghien ciru cao hon 2,6% so vdi trudc khi
dieu tri Methadone. Kit qua nay tuong d6ng vdi kit qua ciia cac nghien cuu khac tren ciing nhom ddi tugng, cho thay tinh trang sii dung ma tiiy tdng hgp cd xu hudng gia tang trong nhom benh nhan dang diiu tri Methadone, vdi ly do su dung hang da cho cam giac "phe" hon, ban be ni re, CO sd khong co xet nghiem nhanh di phat hi?n va tinh trang phd biln ciia ma tiiy da tai thi tradng.
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JOURNAL OF COMMUMTY MEDICINE
Y H O C ^
CX>NG DONG 2018
3. M$t so yeu to liln quan den vi^c tai sir dyng ma tuy cua doi tirong ngliiin cuu
Bdng 3. Mot so yeu to liin quan din viec tai su dung ma tuy cua doi tuffng nghiin cuu
Bien so Tinh trang viec lam Tliat nghiep Co viec lam Tu&i Ian dau tien SDMT
< 25 tu6i
> 25 m6i
Thoi gian SDIVIT truo-c di^u tri Methadone
> 10 nam
< 10 nam Tuan thii diiu tri Khdng Co
NgiTcri thSn/ban be/ban tinh sir dung ma tuy Co
Khong
Sir phi) hgp ve thcri gian hoat dgng ciia cff sf(
Khong phii hgp Phu hop
Thai do ciia can bo y te tai co sii Binh thutmg
T6t
Tai sir dung ma tuy Co n (%)
18 (56,3) 27 (22,0) 35 (35,4) 10(17,9) 38 (34,5) 7(15,6) 24 (49,0) 21 (19,8) 23(51,1) 22 (20,0) 34 (39,1) 11 (16,2) 8(57.1) 37 (26,2)
Khong n (%) 14(43,8) 96 (78,0) 64 (64,4) 46 (82,1) 72 (65,5) 38 (84,4) 25(51,0) 85 (80,2) 22 (48,9) 88 (80,0) 53 (60,9) 57 (83,8) 6 (42,9) 104(73,8)
OR
4,6 1 2,52
1 2,86
1 3,88
1 4,18
1 3,32
1 3,74
1
KTC 95%
2,0-10,3
1,13-5,59
1,16-7,02
1,86-8,11
1,97-8,83
1,53-7,22
1,21-11,52 P
<0,0001*
0,021*
0,018»
<0,0001*
<0,0001*
0,02»
0,03*
Ket qua phan tich cho thay:
- Nhom ddi tugng that nghiep cd nguy co tai sic dung ma tiiy cao hon 4,6 Ian so vdi nhom ddi tugng cd viec lam (p<0,0001).
- Nhom ddi tugng co moi Ian dau tien sic dung ma tiiy dudi 25 tudi cd nguy co tai sir dung ma tiiy cao hon 2,52
\kn so vdi nhdm tir 25 tuoi trd len (p=0,021).
- Nhdm d6i tugng cd thdi gian sir dung ma tiiy tir 10 nam trd len cd nguy co tai su dung ma tiiy cao hon 2,86 Ian so vdi nhdm dudi 10 nam (p=0,018).
- Nhdm ddi tugng khong man thii dieu tri cd nguy co tai su dung ma tuy cao ban 3,88 Ian nhom benh nhan tuan thii diiu tri (p<0,0001}.
- Nhdm ddi tugng co ban be, hg hang, ban tinh dang sir dung ma tiiy co nguy ca tai sir dung ma tiiy cao hon 4,18 Ian so vdi nhdm khong cd ban be/hg hang sir dung ma tuy (p<0,000l),
- Nhdm doi tugng cho rang thdi gian hoat ddng ciia ca sd khdng phii hgp cd nguy co tai su dung ma tiiy cao hem 3,32 Ian so vdi nhdm danh gia phii hgp (p=0,02).
- Nhdm ddi tugng cho rang thai do ciia can bg y te tai co sd binh thucmg co nguy co tai sir dung ma tuy cao hon 3,74 Ian so vdi nhdm danh gia thai do ciia can bg y te tot (p=0,03).
IV. KET LUAN
Ty le doi tugng nghien ciru sir dung ma tiiy ndi chung trong dieu tri Methadone tai co sd dieu tri ciia huyen Dong Anh la 29,0%o; ty le su dung heroin la 21,9%o, su dung ma tiiy da la 12,3%i, sit dung cac loai ma tiiy khac la 3,2%o. Tan suat sir dung trong thang tic 2-3 lan/thang chiem ty le cao nhatla5],l%o.
Ket qua cho thay co moi lien quan c6 y nghia thong ke giira tinh trang vice lam, tuoi tan dau su
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dung ma tiiy, thdi gian sii dung ma tiiy trudc dieu tri tii chdi khi dugc mdi sii dung, tmyen thong nSng cao nhan Methadone, viec tuan thii dieu tri, co ngudi than/ban thicc cho benh nhan ve tac hai cita Methamphetamine, tu be/ban tinh dang sic dung ma tiiy, su phu hgp ve thdi van hd tro tam ly ddi vdi nhiing benh nhan nghi ngd sir gian boat dgng ciia co sd dieu tri, thai do cua can bg y dung hang da.
te tai ca sd dieu tri vdi tinh trang tai sii dung ma tiiy - Bo sung test nhanh phat hien ma tuy tong hgp tai cua cac ddi tugng. co sd dieu tri nham kiem tra, giam sat chat che hanh vi sii
Nghien ciiu dua ra cac khuyen nghi nhu sau: dung cac loai ma ttiy cua ddi tugng
- Tang cudng cac boat ddng m van dieu fri, bao gdm - Sap xep thdi gian boat ddng cua co sd diiu tri cho tu van ve tuan thii dieu tn Methadone, hudng dan ky nang phii hgp vdi nhu cau cua ddi tugng.
TAI LIIPU THAM KHAO
1. Bg Y te (2013), Ddnh gia hieu qud cua chuong trinh thi diim dieu tri nghien cdc chat dang thuocphi^n bang thuoc methadone tai Hdi Phong vd thdnh pho Hd Chi Minh, Hd NQI.
2. Nguyin Thanh Son (2015), Ddnh gid kit qud diiu tri thay thi nghien cdc chdt dang thudcphi^n bang tkudc Methadone tai thdnh pho Tan An. tinh Long An nam 2015. Luan van Thac sy, Truong Dai hgc Y tg Cong cgng. Ha Npi.
3. Nguyen Thi Thuan (2017), Thuc trang su dving ma tuy vd mot sd yiu to hen quan a benh nhan diiu tri methadone tai thdnh pho Hdi Duong nam 2017. Luan van Thac sy, Trudng Dai hgc Y ti Cong cgng. Ha Ngi.
4. Pham Thi Bich (2015), Kit qud diiu tri thay thi nghien cdc chdt dang thudc phien bdng thuoc Methadone va mot so yeu to lien quan tai huyin Kinh Mdn - Hdi Duong nam 2015. Luan van Thac sy, Trudng Dai hgc Y tl Cong cgng, Ha Ngi.
5. Tran Quang Dao (2016), Bd trj cua b^nh nhan diiu tri Methadone tai thdnh pho Hoa Binh tinh Hoa Binkgiai doan 2012-2015: Thuc trgng vd mot so yiu td lien quan. Luan van Thac sy, Trudng Dai hoc Y ta Cong Cgng, Ha Npi
6. C. L. Masson, P. G. Bamett, K. L. Sees et al (2004), Cost and cost-effectiveness of standard methadone maintenance treatment compared to enriched 180-day methadone detoxification. Addiction, 99(6), 718 - 726.
7. J. J. Wammes, A. Y Siregar, T Hidayat et al (2012), Cost-effectiveness of methadone maintenance therapy as HIV prevention in an Indonesian high-prevalence setting: a mathematical modeling study Int J Drug Policy, 23(5), 358 - 364.
8 Linda R. Gowing, Hickman, Matthew, and Louisa Degenhardt (2012), Mitigating the risk of HIV infection mik op,o,dsubsuntton treatment, accessed 13/11/2017, from http://www.who.lnt^uIletin/voIumes/91/2/12-109553/en/
9. Wang R., Dtng Y, Bai H., Duan S , Ye R, Yang Y., Wang J., Tang R., Qao M., He N. (2015), Illicit Heroi. ««i MethantphemmirteUse an,o„g Methadone Maintenance Treatment Patients in Dehong Prefecture of Yunnan Pnmnce.
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