Y HOC VI$T NAM THANG 8 - S6 1/2013
C O N G T R I N H N G H I E N COU
DANH GIA HIEU QUA DIEU TRj NGHIEN CAC CHAT DANG THUOC PHIEN DANG METHADONE TAI THANH PHO HO CHJ MINH VA HAI PHONG (2009 -2011)
NguySn Thanh Long*, Hodng Dinh Canh*
Nguyen Vin Hu'ng**
T O M TAT
Trien khai thi diem dieu tri nghien cac chat dang thudc phien bang methadone clio 965 benh nhan tai 2 thanh pho Ho Chi Minh va Hai Phong vdi thdi gian ta 2 nam (11/2009 - 11/2011). Dinh gia bu'dc dau dat du'dc mpt so hieu qua: Benh nhan giam sif dung ma tuy (ty le du'dng tfnh vdi ma tuy khi xet nghiem nu'dc tieu giam manh tif 98,2% tru'dc khi dieu tri xuong 15,5% sau 12 thang va 12,4% sau 24 thang; Ty le tiem chich ma tuy giam manh tif 92,7% (ban dau) xuong 7,5% sau 12 thang dieu tri va 6,7% sau 24 thang; Ty le co quan he tinh due (QHTD) tang tif 46,7% tru'dc dieu tri len 65,9% sau 12 thang va 71,9% sau 24 thang; Ty le diing bao cao su khi QHTD vdi gai ban dam tSng tir 93,1% len 100% sau 12 thang; Ty le nhiem HIV/AIDS giCf nguyen d mirc 28,4%; Hanh vi pham phap giam tir 40,8% xuong 2,2% sau 12 tiiang va 1,6% sau 24 thang; Hanh vi bao luc gia dinh giam manh tif 90,4% xuong 2,5% sau 12 thang va 2,3% sau 24 thang; Cd viec iam tSng len them 9,0% - 11,9%; Co van de sifc khoe tam than giam 36,9% va 34,8%; Chat lu'dng cuoc song tir tot trd len tSng them 34,7% - 39,2%...
Tu'khoa: Mo hinh, thi diem, dieu tri nghien, chat dang thuoc phien, methadone.
SUMMARY
ASSESSMENT ON THE EFFECTIVENESS OF METHADONE TREATMENT FOR OPIOID ADDICnON I N HO CHI MINH AND HAI PHONG
CITY ( 2 0 0 9 - 2 0 1 1 )
' The pilot methadone treatment of opiate addiction was implemented in 965 patients in Ho Chi Minh and Hai Phong City during 2 years (11/2099 - 11/2011). Some efficiencies gained v/ith initial [assessment: Reducing the frequency of drug using '(positive rate with the drug detected through unne itest decreased from 98.2% before treatment to 15.5%
[after 12 months of treatment and 12.4% after 24 months of treatment; The rate of injecting drug users Wecreased from 92.7% (initially) to 7.5% after 12 Tionths of treatment and 6.7% after 24 months of jeatment; The rate of patients who having sex (sex) ncreased from 46.7% before treatment to 65.9% after 12 months of treatment and 71.9% after 24 months of
*B6Y te"; * * Hoc vien Quin y
^han bien khoa hoc: GS.TS. Vu Sinh Nam
treatment, the rate of patients who had sex with prostitutes using condom increased from 93.1% to 100% after 12 months of treatment. The prevalence of HIV/AIDS remained at 28.4%, the illegal behavior rate fell from 40.8% to 2.2% after 12 months of treatment and 1.6% after 24 months of treatment; Domestic violence rate decreased from 90.4% to 2.5% after 12 months of treatment and 2.3% after 24 months of treatment; The rate of employed patients increased 9,0% - 11.9%; The rate of patients having mental health problems fell to 36.9% and 34.8%; The rate of patients having good quality of life increased from 34.7%-39.2%...
Keywords: Model, pilot, addiction treatment, opiate, methadone.
I. BATVA'NOE ^
Tru'dc khi trien khai md hinh thf diem dieu tri (DT) nghien cac chat dang thudc phien (CDTP) bang methadone cho 955 benh nhan (BN) nghien ma tuy d Hai Phdng va thanh phd Ho Chl Minh, tien hanh dieu tra thtfc trang thay:
82,7% nghien ma tuy tif 10 n5m t r d xudng;
83,4% su' dung ma tuy bang du'dng tiem chich;
98,2% cd cliat ma tuy trong nu'dc tieu; 28,4%
nhiem HIV; 16,4% nhiem HBV; 56,9% nhiem HCV. Trong sd ngu'di tiem chich ma tuy, ty le sif dung Chung BKT la 4 , 1 % . 40,8% ed hanh vi vi pham phap luat; 13% va 20,6% la cd tien sir va tien an; 90,4% cd hanh vi bao life gia dinh;
73,5% ed van de sifc khoe tam than; chl cd 29,6% ia hai Idng vdi sifc khoe...
Tir thtfc trang tren, 6 cd sd thf diem dieu trj nghien eae chat dang thudc phien bang Methadone cho cae benh nhan du'dc to chu'c thife hien theo quyet dinh cua Thii tu'dng Chi'nh piiii va Bd Y te tai thanh phd Ho Chi Minh va Hai Phdng trong 2 nam (11/2009 - 11/2011). Oe ed can cir khoa hpc giiip eho cac nha hoach djnh chinh sach va eae tinh, thanh pho trong viee trien khai cdng tac dieu b i nghien cae chat dang thuoc phien bang thudc Methadone tai cae tfnh/ttianh pho trang ea nUdc. Muc tieu eiia nghien culj nay la: Danh gia hieu
Y HQC VigT NAM THANG B - S6' 1/2013
qua bu'dc dau mo hinh thf diem dieu tri nghien cac chat dang thuoc phien bSng methadone thanh phoHd Chi'l^inh va Hai Phong (2009-2011).
II. 061 TUpNG VA PHUONG PHAP NGHllN CUU 1. Odi tu'dng, thdi gian nghiSn cu'u - 965 benh nhan (467 BN d Hai Phdng va 498 BN dTp. Ho Chf Minh) da tif nguyen d^ng ky va difdc chpn vao mau nghien cifu tru'dc dieu tn.
Sau 12 thang ed 113 BN bd tri, sd cdn lai la 852 BN tiep tyc tham gia nghien cifu.
- Thdi gian nghien cu'u can thiep la -2 nam (tif 11/2009 den 11/2011).
III. KE'T Q U A N G H I E N C U U
1. Tinh trang benh nhan bd dieu trj sau 12 thang va 24 thang Bang 1. Tinh trang tuan thii dieu trj methadone
2. Sanh gia hieu qua can thi#p - Doi tu'dng nghien etfu se du'dc theo doi, danh gia sif thay dd'i theo thdi gian sau 12 ttiang va sau 24 thang dieu trj. Cac phan tfch so sanh du'dc tien hanh ddc lap tren hai ket qua nghien culj can thiep tai thanh phd Ho Chf Minh va Hai Phdng.
- Chi sd hieu qua (CSHQ) du'dc tfnh theo cong thife:
CSHQ(%)= ^-^—-^x 100%
(PI: Ty le tru'dc can thiep; P2: Ty le sau - can thiep).
Tmh trang dieu trj BN tuan thif dieu tri BN bo dieu tn
Bat dau dfeu tri ( n = 9 6 5 ) C l ) SL 965 0
100
%
0
Sau 12 thang Sau 24 thang ( n = 9 6 5 ) (2) ( n = 9 6 5 ) (3) SL
852 113
88,3
%
11,7 SL 751 214
77,8
%
22,2
Ty le benh nhan bd dieu tri sau 12 thang la 11,7% va sau 24 thang la 22,2%.
2. Hieu qua dat du'dc ve giam siir dung ma tuy, giam hanh vi nguy cd va nhiem HIV, HBV, HCV cua BN dieu tri Methadone
mo Tv rr.
1$
"
100,0%
15,5% 12,4%
TrirocDI (nH)43) Sau 12 thiing OT(n=851) Suu 2-1 thang DT(n=749)
Bieu do 3.1. Ty le BN du'dng tfnh vdi ma tuy khi xet nghiem nu'dc tieu Ty le BN du'dng tinh vdi ma tuy khi XN nu'dc tieu da giam tif 100,0% (tru'dc DT) xudng la 15,5%
(sau 12 thang DT) va 12,4% (sau 24 thang DT), CSHQ dat 84,5% va 87,6% (p<0,001).
82,7%
^W
- -. ._ _ ._.
CSHQ = 90,9% va 91,9%
7,5% 6,7%
Trirfrc Dl{n=965) 12 thdng i)T(n=852) u 24 (hang DT(n=751)
_ Bieu do 2. Ty le benh nhan cd tiem ehi'eh ma tuy
Ty le BN cd tiem chich ma tuy da giam tir 82,7% (tru'dc OT) xuong 7,5% (sau 12 thang DT) va
6,7% (sau 24 thang DT), CSHQ dat 90,9% va 91,9% (p<0 001)
Y HQC VIET NAM THANG 8 - s 6 1/2013
Banq 2. Ty le benh nhan dCina chuna bdm l<im tiem Tinh trang dung chung
BKT Co diing Chung
CSHO:P
Tru'dc dieu tri (n=965) { ! ) • SL 41 (CSH0=7U')i
%
Sau 12 thang (n=852) (2) =;
SL
%
Sau 24 thang '.. ( n = 7 5 1 ) ( 3 )
SL 4,2 10 1,2 8 :p,., <o,ooi): (C5HO=73,S%:P,., <O,OOI)
1,1
%
Ty ie BN dung chung BiCT khi tiem chich ma tuy so vcfi so benh nhan tham gia nghien cu'u da giam tff 4 , 2 % (tru'dc DT) xuong 1,2% (sau 12 thang DT) va 1 , 1 % (sau 24 thang DT), CSHQ dat 71,4% va 73,8%, sir khac biet nay co y nghta thong ke v i i p<0,001.
Banq 3. Ty le dijnq chuna BKT tronq so benh nhan co tiem chich ma tuv
Dung Chung BKT Co dung chung
P
Tru'dc dieu tri Cn=B01) (1) SL [ % _____ 41 1 5,J
p,.j <0,d5;
Sau 12 thang (n=64) (2) SL 1 % 10, 1 15,6
A-? <0,05
Sau 24 thang Cn=50) (3) SL I %
8 16,0 So BN diing ehung BKT khi tiem chich ma tuy mac dii cd giam di nhieu sau dieu tn (tif 41 ngu'di xudng cdn 10 ngu'di sau 12 thang va 08 ngu'di sau 24 thang dieu tri, tuy nhien khi so vdi so benh nhan cdn tiem chich ma tuy thi ty le cd sif tang len tif 5 , 1 % (41/801 BN tru'dc DT) len 15,6% (10/64 BN sau 12 thang DT) va 16% (8/50 BN sau 24 thang DT), (p<0,05).
Tru'6cDT(n=965) Sau 12 thing DT(n=8S2) Sau 24 thing »T(n=7SI) Bieu do 3. Ty le benh nhan cd quan he tinh due
Ty le BN cd QHTD da tang tif 46,7% (tru'dc DT) len 65,9% (sau 12 th^ng DT) va 71,9% (sau 24 thang DT), CSHQ dat 4 1 , 1 % va 54% (p<0,01).
120
40
" "1 CSHQ = 6,9% 1"
86,2%
100%
- ---•
100%
!
TrifO-c D T (n=30) u 12 thang D T (n=46) Sau 24 thang D T (n=31) Bieu do 4. Ty le benh nhan sif dung BCS khi QHTD vdi GBD
Ty le BN cd diing BCS khi QHTD vdi GBD tang tif 86,2% (tru'dc DT) len 100% (sau 12 va 24 thang DT), CSHQ dat 16,0 (p<0,05).
Bang4.X\v\h tranq nhiem HIV ciia benh nhan dieu tri
Tinh hinh nhilm HIV HIV (+)
,„_HIV(:)_ _ _ _ _ o
Tru'dc dieu tri (n=965) (1) SL 274 421
»/o 28,4 71,6 P,
Sau 12 thang ( n = 8 5 2 ) ( 2 ) SL 241 611
28,3
%
71,7 P,-,>d:o
Sau 24 thang ( n = 7 5 1 ) ( 3 ) SL 213 538 5
28,4
%
71,6
Y Hi;X:VIJT NAM THAllGt-so 112013
Ty le BN nhiem HIV/AIDS twcic dieu tri va sau dieu trj khong co s^ khac biet (p>0,05): tnf&
dieu tri 1^ 28,4% sau 12 thang DT la 2 8 , 3 % va sau 24 thang OT la 28,4 va p>0,05.
Tlieo doi trong 02 n i m dieu tr] MMT chi co 01 benh nhan bi nhian mdi HIV.
Banq 5, Ty le benh nhan mSc viem qan B, C Mac b^nh
Viem qan B(+) Viem qan C (+)
Tru'dc OT (I) (n=965)
16,4
Sau 12 thang ( n = 8 S 2 ) ( 2 ) p,.j>0,05;
I 17,8
Sau 24 thang ( n = 7 5 1 ) ( 3 )
S6-9 I 62,0
D,.i J- 0,05
I 44; 593
p,.2> 0,05; Pi.j > 0.05
- Ty le BN mSc viem gan B tif 16,4% (tru'dc DT) tSng len 1 7 , 8 % (sau 12 thang OT) va 18,2%
(sau DT). Tuy nhien, su' khac biet 2 ty le la khong co 'j' nghia thong ke {p>0,05). "
- Ty le BN mSc viem gan C tir 56,9% (tru-*: OT) tSng len 6 2 % (sau 12 thang OT) va 59,8% (sau OT). Tuy nhien, sir khac biet giua 2 ty le la khong cd y nghia thong ke (p>0,05).
Bang 6. Ty le BN xet nqhiem mau cd dUdnq mdi vdi HBV va HCV 1 Sau 12 t h i n g
Nhiem niOi j ^ i .^^^.^
HBV(+) t 12/712 1 1,7 HO/(+) ! 43/367 1 11,7
Sau 24 thanq SL 14/616 22/281
TL 2,3 7,8
P 1 <0,!)S 1 <0,05 Ty le BN du'dng tinh mcfi vdl HBV va HCV la 1,7% va 11,7% (sau 12 thang DT) va 2,3% va 7,8%
(sau 24 tiiang DT). Su^ khac biet giiia 2 ty le la cd y nghia thdng ke (p<0,05).
3. Hieu qua d a t di/dc v e sii'c khoe va xa hoi
Bang 7. T'/ le BN cd hanh vi vi pham phap luat va bao \\ic qia dinh Chi tieu danh gia
Tru'dc BT (1) ( n = 9 6 5 )
Sau 12 t h i n g ( 2 ) ( n = 8 5 2 )
Sau 24 thang (3) l n = 7 5 1 ) Co hanh vi vi pham phap luat
i CSHO: P . Co hanh vi bao It/c gia dinh i CSHO:P
394 , 40,8 19 1 2,2 12 1,6 (CSHQ^94,6%;p,.,<0,001):(CSHO=96,l%;p ,<0,001) 872 1 90,4 1 21 1 2,5 17 2.3
(CSH0=97J%: p,.,< 0,001):(CSHO=97,5%:p..,<O.OOl) - T-/ le BN cd hanh vi vi pham phap luat tiT 40,8% (tru'dc OT) da giam xuong 2 , 2 % (sau 12 thang DT) va 1,6% (sau DT). Stf khic biet giiia 2 ty le la rat cd y nghia thong ke (p<0,001); CSHQ dat 94,6% va % , 1 % .
- Ty le BN cd hanh vi bao lut gia dinh tir 90,4% (dvdc DT) da giam xudng 2 , 5 % (sau 12 thang OT) va 2,3% (sau DT). Si/ khac biet giiia 2 ty le la rat od y nghia thong ke (p<0,001); CSHQ dat 97,2% va 97,5%.
CSHQ= 14.1% ial8,6%
Trwit DT(B=96S) S I S 12 thaag DT(a=S52) Sa* 24 ikiag DT(a=''51) BieuddS.Ty\e benh nhan od viec lam
Ty le BN cd viec lam tang t.- 54% (tn/dc DT) len 7 3 % (sau 12 thang OT) va 7 5 , 9 % (sau 24 thang OT), CSHQ dat 1 4 , 1 % va 18,6% (p<0,05).
Y HQC VIET NAM THANG 8 - SO 1/2013
7 3 , 5 %
1 CSHQ =50,2% va47,3%
Trwfrc D T (n=965) Sau 12 t h i n g D T ( n ^ 8 5 2 ) Sau 24 t h i n g D T ( n » 7 5 1 )
Bieu do 6. Ty I? benh nhan co van de sii'c khoe tam than
Ty le BN c6 van de siTc khoe tam than td 73,5% (tru'dc OT) giam xuong 36,6% (sau 12 thang OT) va 38,7% (sau 24 thang OT), CSHQ dat 50,2% va 47,3% (p<0,001).
j CSHQ = 218,2% va 246,5% | i ' ""
0
15,9%
1 1
...m,w^. - -
--- - '
55,1% .
Trirdc DT (n=965) Sau 12 Ihing DT (n=852) Sau 24 thing DT (n=7S1)
Bieu dio 7. Ty le BN tu" danh gia co chat lu'dng cupc song tu" tot trd len Ty le BN c6 chat lu'dng cuoc song tu" tot trd len td 15,9% (tru'dc OT) da tang len 50,6% (sau 12 thang DT) va 55,1% (sau 24 thang OT), CSHQ dat 218,2% va 246,5% (p<0,001).
1 _.- ,
. 60 - 40 20
0
j _ - „ 1 81,6%
03 B<" 31 1 "
---
Tru-<^cDT(n=965) Sau 12 thing DT(n=852) Sau 24 thing DT(n=751)
Bieu &6 8. Ty le BN hai long vdi sii'c khoe cua minh
Ty le BN hai long vdi sii'c khoe cua minh tu" 81,6% (tru'dc OT) da tang len 93,8% (sau 12 thang DT) va 94,1% (sau 24 thang OT), CSHQ dat 15,0% va 15,3% (p<0,05).
Bang 8. Ty ie BN tiep can, sii' dung dich vu y te va dich vu ho trd xa hoi
chi tieu danh gia Tiep c a n , siJ' d u n g DVYT
P Tiep c a n , siJ d u n g DVHTXH
P
TrUdc BT (1) (n=965) SL 1 % 6 9 9 J 72,4 (CSH0=7.2 150 1 15,5 (P,.
Sau 12 thang (n=852) (2)
SL 1 %
6 6 1 1 7 7 , 6
%:P,.! <O,05):(CSHQ=J2..
117 1 13,7
>0,05); (p,.:>C Sau 24 thang
( n = 7 5 1 ) ( 3 ) SL 610 81,2
%
:P,.,<O.OI) 117 1 15,7 ,01)
Y HQC VigT NAM THANG B - S6' 1/2013 IV. BAN LUAN
- Ket qua nghien cu'u cua de tai da chutig minh cho ly thuyet methadone lam giam str^dung ma tiiy bat hdp phap la phii hdp vdi thu'c tien: ty le BN du'dng tinh vdi ma tuy khi XN nu'dc tieu da giam tir 100% (tru'dc OT) xuong la 15,5% (sau 12 thang DT) va 12,4% (sau 24 thang DT) vdi p<0,001, CSHQ dat du'dc sau 12 thang 84,2% va sau 24 thang 87,4%. Ket qua nghien cifu ciia Vien Sire khoe Tam than, Benh vien Bach Mai ve DT methadone tai Viet Nam (nghien ciru dau tien tai Viet Nam), dieu trj thf diem methadone tai Tp.
Ha Npi (vdi 68 ngu'di TCMT) va thanh pho Hai Phong (vdi 74 ngu'di TCMT), thdi gian tir 1996 den nam 2002, Ket qua da lam giam ro ret hanh vi sir dung CDTP bat hdp phap: Ty le ngu'di sir dung ma tuy giam tir 100% xuong con 18% sau 6 thang va chl con 9 % sau 2 nam DT [ 3 ] . Ket qua nghien ciTu ciia Simpson DD, Sells SB ve
"can thiep hieu qua OT cai nghien ma tuy: tong quan ve cac chu'dng trinh nghien cii'u ciia DARP (1982)", vdi cS mau la 4.627 ngu'di dang DT cai nghien tai 34 cd sd dai dien ciia DARP (trong dd cd 1.856 ngu'di tham gia DT thay the bang methadone), thdi gian nghien cu'u tir 1969 den 1973, tinh hinh sir dung ma tuy hang ngay ciia ngu'di nghien, tru'dc DT 2 thang la 100%, sau 01 nam OT ty le nay giam xuong con 3 6 % va sau 03 nam DT giam xuong 2 2 % [ 7 ] . Ket qua nghien ciru cua Hubbard RL, Marsden ME, Rachal JV, Harwood HJ, Cavanaugh ER, Ginzburg HM, nghien ciru TOPS. TOPS la mot nghien ciru keo dai nhieu nam vdi hdn 10.000 ngu'di sir dung ma tiiy khi tham gia DT tir nam 1979, 1980 va 1981, cd gan 64% ngu'di benh sir dung Heroin i't nhat hang tuan trong 01 nam tru'dc OT, tuy nhien ty le nay giam xuong chi cdn 18% sau 1 nam DT methadone va cd khoang 19% van tiep tuc sir dung Heroin hang tuan sau 3 den 05 nam DT [5]. Nghien ciTu khac ciia Simpson DD, Sells SB, Nghien CDTP va OT: 12 nam theo doi (1990) cung cho thay trong 697 ngu'di tham gia nghien ciru sau 12 nam ty le 7 6 % so ngu'di con lai khong sir dung ma tuy CDTP thu'dng xuyen.
- Ket qua nghien cii'u ciia de tai cho thay ty le BN cd TCMT 6a giam tir 82,7% (tru'dc DT) xuong 7,5% (sau 12 thang OT) va giam xuong con 6,7% (sau 24 thang DT), su' khac biet glCTa tru'dc DT vdi sau OT 12 thang va 24 thang cd y nghia thdng ke vdi p < 0 , 0 0 1 , CSHQ dat du'dc sau 12 thang 90,9% va sau 24 thang la 91,9%! Ty le
TCMT cung giam trong nghien cii'u ciia Vien SiTc khoe Tam than, Benh vien Bach Mai, ty le nay la 3 5 % khi b i t dau nghien ciru va giam xuong con 3,2% sau 1 thang, khong con tru'dng hdp nao TCMT sau 18 thang, khong nhiem HIV trong qua trinh nghien ciiXJ [ 3 ] ,
- Ket qua nghien cii'u con cho thay so BN diing chung BKT khi TCMT mac dii co giam di rat nhieu, tir 41 ngu'di diing chung BKT luc tru'dc OT, giam xuong cdn 10 ngu'di diing chung BKT sau 12 thang va chi con 8 ngu'di diing chung BKT sau 24 thang DT. Ket qua nghien ciru cua Ball JC, Lange WR, Meyers CP, Friedman SR (1998) cung cho thay DT methadone lam giam nguy ai lay nhiem AIDS, giam TCMT, giam diing chung BKT trong nhdm nghien chich Heroin. Ngu'di nghien chich ma tuy khi bd OT thay the bSng thuoc methadone cang lau thi nguy cd tai sir dung ma tuy cang cao, ty le quay lai tiem chich sau 1-3 thang bd DT la 4 5 , 5 % , sau 4-6 thang bo OT 57,6%, sau 7-9 thang bd OT la 72,7%, sau 12 thang b d D T I a 8 2 , l % [ 4 ] .
- Ket qua nghien ciilj ciia de tai cung chiilig minh cho thay ty le benh nhan cd dung BCS khi QHTD vdi GBD tang t i f 8 6 , 2 % (tru'dc OT) len 100% (sau 12 va 24 thang dieu tri methadone), sir khac biet nay cd y nghia thong ke vdi p< 0,05 va CSHQ dat 16,0%.
- Ket qua nghien ciru ciia de tai da cho thay ty le BN nhiem HIV/AIDS tru'dc DT va sau OT khong cd sd khac biet vdi p>0,05: tru'dc OT la 28,4% sau 12 thang DT la 2 8 , 3 % va sau 24 thang OT la 28,4 va p>0,05, trong 02 nann DT trong so nhutig BN tham gia chu'dng trinh methadone chi cd 01 BN bi nhiem mdi HIV, so sanh vdi ti le nhiem mdi, t y le nhiem HIV trong cong dong ciing thdi gian do da cho thay hieu qua cua methadone trong phdng, chong lay nhiem HIV tai Viet Nam, day la mpt trong nhiihg giai phap hull hieu (qua dam thep) trong viec day Iiil djch HIV tai Viet Nam. Theo IBBS nam 2011, ty le hien nhiem HIV trong nhom nam TCMT ciia Tp HCM da tang tir 3 4 % len 46%, ty te nay^d TP. Hai Phdng la 4 8 % . [ugass 2012]. Ty le nhiem mdi HIV cua Tp HCM va Tp HP nam 2011 lan lu'dt la 2 , 2 % va 0,76%. Ket qua nghien ciru ciia Chung toi cung tu'dng dong vdi cac ket qua nghien ciru cua cac tac gia nu'dc ngoai khac.
Nghien cuTu ciia Metzger DS, Woody GE, McLellafi AT, O'Brien CP, Druley P, Navaline H, ttnh trang lay nhiem HIV qua du'dng mau d 02 nhdm ngiTcli TCMT du'dc OT va khong du'dc DT thay the bang
Y HQC VigT NAM THANG B - s 6 1/2013 thudc methadone sau 18 thang theo ddi (1993).
Tai thdi diem bat dau DT thay the bang thuoc methadone ty le nhiem HIV d nhdm du'dc DT la 1 1 % , ty le nhiem HIV d nhdm khong du'dc DT la 18%. Sau 18 thang nghien ciili, ty le xet nghiem du'dng tinh vdi HIV d nhdm du'dc OT 15%, ty le nay d nhdm khong du'dc DT la 3 3 % , su" khac biet cd y nghTa thong ke vdi p<0,01 [ 6 ] .
- Ket qua nghien ciru ciia de tai ve hanh vl bao lu'c gia dinh cho thay cd sd giam di ro ret, tru'dc OT methadone la 9 0 , 4 % , sau 12 thang DT da giam xuong 2,5% va chl con 2,3% sau 24 thang DT. Tu'dng tu", ty le BN cd hanh vi vi pham phap luat cung giam rat nhieu so vdi ket qua tru'dc DT methadone la 40,8%, sau 12 thang OT da giam xudng 2 , 2 % va sau 24 thang da giam xuong 1,6%. Ket qua nghien ciTu ciia chiing toi cung tu'dng dong vdi cac ket qua nghien ciru ciia Ball JC, Ross A ve hieu qua chu'dng trinh OT thay the nghien cac CDTP bang methadone da lam giam dang ke ngay lien quan den pham tpi trung binh moi nam; so ngay lien quan den pham toi trung binh tru'dc dieu tri la 237,5. Sau 4 thang DT bang methadone so ngay lien quan den pham tpi trung binh giam xuong cdn 69,3, sau 3 nam la 12,4, sau 6 nam la 14,5 [ 4 ] .
V. KET LUAN
Ty le BN du'dng tfnh vdi ma tuy khi XN nu'dc tieu giam tir 9 8 , 2 % tru'dc khi DT xudng 15,5% sau 12 thang va 12,4% sau 24 thang (CSHQ: 8 4 , 2 % va 8 7 , 4 % ; p<0,001). Cd TCMT giam tir 92,7% ban dau xuong con 7,5% sau 12 thang DT va 6,7% sau 24 thang (CSHQ: 91,9%
va 92,8%; p < 0 , 0 D l ) .
- Cd QHTD tang tir 4 6 , 7 % tru'dc khi OT len 65,9% sau 12 thang va 7 1 , 9 % sau 24 thang (CSHQ: 4 1 , 1 % va 5 4 , 0 % ; p<0,001). Diing BCS ' khi QHTD vdi gai ban dam tang tir 9 3 , 1 % len
! 100% sau 12 thang va 24 thang DT(CSHQ '' 7,4%;7,4% p>0,05).
- Ty le nhiem HIV/AIDS giQ" nguyen d mu'c ' 28,4% (p>0,05); ty le du'dng ti'nh mdi vdi HBV la - 1 , 7 % va 2,3% vdi HCV la 11,7% va 7,8%; ty le f mac viem gan B tang 1,4% va 1,8%; ty le mac Iviem gan C tang 5 , 1 % va 2,9% (p>0,05).
i - Co hanh vi vi pham phap luat giam tir j'40,8% xudng 2 , 2 % sau 12 thang va cdn 1,6%
H I!
sau 24 thang OT (CSHQ: 94,6% va 9 6 , 1 % ; p<0,001). c d hanh vi bao It/c gia dinh giam tir 90,4% xuong 2,5% sau 12 thang va cdn 2,3%
sau 24 thang (CSHQ: 97,2% va 97,5%;
p<0,001); cd viec iam tang tir 6 4 % len them 9,0% vao 12 thang va them 11,9% sau 24 thang (CSHQ: 1 4 , 1 % va 18,6%; p<0,05); cd van de sire khoe tam than giam 36,9% va 34,8%
(CSHQ: dat 50,2% va 47,3%; p<0,001); cd chat lu'dng cupc sdng tir tdt trd len tang them 34,7%
sau 12 thang va them 39,2% sau 24 thang (CSHQ: 218,2% va 246,5%; p<0,001). Hai long vdi sire khoe t i n g them 12,2% va 12,5% (CSHQ:
15,0% va 15,3%; p<0,05).
TAI LIEU T H A M K H A O
1. Bp Y te' (2007), De an tnen ichai thi diem dieu tri nghien cac chat dang thuoc phien bing thuot i^ethadone tai thanh pho Hai Phong va thanh pho Ho Oil Mmh, (Ban hanh kem theo Quyet dinh so 5037/QD-Bin" ngay lliWimi cua Bp Y ^ . 2. Bp Y te (2007), Hu'dng dan Chi'n doan ngWdi
nghien ma tuy nhom Opiats (chat dang thuoc phien). Ban hanh kem theo Quyet drnh so 5075 / Q D - B n ngay 12 thang 12 nam 2007cua Bp tru'cfng Bp Y te.
i. Vien SIJ'C khoe tam than, Benh vi^n Bach Mai (2005), Wghien cuV thi diem dieu tn thay the nghien chat dang thuoc phien bing thuoc Methadone tai Tp Ha Noi va Tp Hai Phong, Bao cao de tai nghien cinj cap Bo.
4. Ball JC, Ross A (1991), The Effectiveness of Methadone Maintenance Treatment: Patients, Programs, Services, and Outcomes. New York:
Springer-Verlag.
5. Hubbard RL, Marsden ME, Rachal JV, Harwood HJ, Cavanaugh ER, Ginzburg HM (1989), Drug Abuse Treatment: A National Study of Effectiveness. Chapel Hilt, University of North Carolina Press.
o. Metzger DS, Woody GE, McLellan AT, O'Brien CP, Druley P, Navaline H, et al (1993), Human immunodeficiency virus seroconversion among intravenous drug users in- and out-of-treatment: an 18-month prospective foiiow-up. Journai of Acquired Immune Deficiency Syndrome; Vol 6:1049-56.
/ . Simpson DD, Sells SB (1982), Effectiveness of treatment for drug abuse: an overview of the DARP research program. Psychology of Addictive Behaviors, Vol 7(2), Jun 1993,120-128.
