Retention of participants in medication-assisted programs in low- and middle-income countries

An international systematic review

Jonathan Feelemyer, Don Des Jarlais, Kamyar Arasteh, Abu S. Abdul-Quader, Holly Hagan

Research output: Contribution to journalArticle

Abstract

Background and aims: Medication-assisted treatment (MAT) is a key component in overdose prevention, reducing illicit opiate use and risk of blood-borne virus infection. By retaining participants in MAT programs for longer periods of time, more noticeable and permanent changes in drug use, risk behavior and quality of life can be achieved. Many studies have documented retention in MAT programs in high-income countries, using a 50% average 12-month follow-up retention rate as a marker for a successful MAT program. This study contributes to a systematic understanding of how successful programs have been in retaining participants in low- and middle-income countries (LMIC) over time. Methods: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic literature search to identify MAT program studies that documented changes in retention over time for participants in buprenorphine and methadone programs in LMIC. Retention was measured for participants by length of follow-up, type of MAT and treatment dosage. Results: There were 58 MAT program studies, with 27047 participants eligible for inclusion in the review. Overall average retention after 12 months was 54.3% [95% confidence interval (CI)=46.2, 63.7%]. Overall average retention was moderately good for both buprenorphine (48.3%, 95% CI=22.1, 74.6%) and methadone (56.6%, 95% CI=45.9%, 67.3%) after 12 months of treatment. Among programs using methadone there was no statistically significant difference in average retention by dosage level, and the 10 highest and lowest dosage programs obtained similar average retention levels after 12 months. Conclusion: Medication-assisted treatment programs in low- and middle-income countries achieve an average 50% retention rate after 12 months, with wide variation across programs but little difference between those using buprenorphine versus methadone.

Original languageEnglish (US)
Pages (from-to)20-32
Number of pages13
JournalAddiction
Volume109
Issue number1
DOIs
StatePublished - Jan 2014

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Methadone
Buprenorphine
Confidence Intervals
Opiate Alkaloids
Virus Diseases
Risk-Taking
Meta-Analysis
Quality of Life
Guidelines
Pharmaceutical Preparations

Keywords

  • Buprenorphine
  • Developing countries
  • Low- and middle-income countries
  • Methadone
  • Opiate abuse
  • Opiate substitution programs

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Psychiatry and Mental health
  • Medicine(all)

Cite this

Retention of participants in medication-assisted programs in low- and middle-income countries : An international systematic review. / Feelemyer, Jonathan; Des Jarlais, Don; Arasteh, Kamyar; Abdul-Quader, Abu S.; Hagan, Holly.

In: Addiction, Vol. 109, No. 1, 01.2014, p. 20-32.

Research output: Contribution to journalArticle

Feelemyer, Jonathan ; Des Jarlais, Don ; Arasteh, Kamyar ; Abdul-Quader, Abu S. ; Hagan, Holly. / Retention of participants in medication-assisted programs in low- and middle-income countries : An international systematic review. In: Addiction. 2014 ; Vol. 109, No. 1. pp. 20-32.
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title = "Retention of participants in medication-assisted programs in low- and middle-income countries: An international systematic review",
abstract = "Background and aims: Medication-assisted treatment (MAT) is a key component in overdose prevention, reducing illicit opiate use and risk of blood-borne virus infection. By retaining participants in MAT programs for longer periods of time, more noticeable and permanent changes in drug use, risk behavior and quality of life can be achieved. Many studies have documented retention in MAT programs in high-income countries, using a 50{\%} average 12-month follow-up retention rate as a marker for a successful MAT program. This study contributes to a systematic understanding of how successful programs have been in retaining participants in low- and middle-income countries (LMIC) over time. Methods: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic literature search to identify MAT program studies that documented changes in retention over time for participants in buprenorphine and methadone programs in LMIC. Retention was measured for participants by length of follow-up, type of MAT and treatment dosage. Results: There were 58 MAT program studies, with 27047 participants eligible for inclusion in the review. Overall average retention after 12 months was 54.3{\%} [95{\%} confidence interval (CI)=46.2, 63.7{\%}]. Overall average retention was moderately good for both buprenorphine (48.3{\%}, 95{\%} CI=22.1, 74.6{\%}) and methadone (56.6{\%}, 95{\%} CI=45.9{\%}, 67.3{\%}) after 12 months of treatment. Among programs using methadone there was no statistically significant difference in average retention by dosage level, and the 10 highest and lowest dosage programs obtained similar average retention levels after 12 months. Conclusion: Medication-assisted treatment programs in low- and middle-income countries achieve an average 50{\%} retention rate after 12 months, with wide variation across programs but little difference between those using buprenorphine versus methadone.",
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AU - Feelemyer, Jonathan

AU - Des Jarlais, Don

AU - Arasteh, Kamyar

AU - Abdul-Quader, Abu S.

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N2 - Background and aims: Medication-assisted treatment (MAT) is a key component in overdose prevention, reducing illicit opiate use and risk of blood-borne virus infection. By retaining participants in MAT programs for longer periods of time, more noticeable and permanent changes in drug use, risk behavior and quality of life can be achieved. Many studies have documented retention in MAT programs in high-income countries, using a 50% average 12-month follow-up retention rate as a marker for a successful MAT program. This study contributes to a systematic understanding of how successful programs have been in retaining participants in low- and middle-income countries (LMIC) over time. Methods: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic literature search to identify MAT program studies that documented changes in retention over time for participants in buprenorphine and methadone programs in LMIC. Retention was measured for participants by length of follow-up, type of MAT and treatment dosage. Results: There were 58 MAT program studies, with 27047 participants eligible for inclusion in the review. Overall average retention after 12 months was 54.3% [95% confidence interval (CI)=46.2, 63.7%]. Overall average retention was moderately good for both buprenorphine (48.3%, 95% CI=22.1, 74.6%) and methadone (56.6%, 95% CI=45.9%, 67.3%) after 12 months of treatment. Among programs using methadone there was no statistically significant difference in average retention by dosage level, and the 10 highest and lowest dosage programs obtained similar average retention levels after 12 months. Conclusion: Medication-assisted treatment programs in low- and middle-income countries achieve an average 50% retention rate after 12 months, with wide variation across programs but little difference between those using buprenorphine versus methadone.

AB - Background and aims: Medication-assisted treatment (MAT) is a key component in overdose prevention, reducing illicit opiate use and risk of blood-borne virus infection. By retaining participants in MAT programs for longer periods of time, more noticeable and permanent changes in drug use, risk behavior and quality of life can be achieved. Many studies have documented retention in MAT programs in high-income countries, using a 50% average 12-month follow-up retention rate as a marker for a successful MAT program. This study contributes to a systematic understanding of how successful programs have been in retaining participants in low- and middle-income countries (LMIC) over time. Methods: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic literature search to identify MAT program studies that documented changes in retention over time for participants in buprenorphine and methadone programs in LMIC. Retention was measured for participants by length of follow-up, type of MAT and treatment dosage. Results: There were 58 MAT program studies, with 27047 participants eligible for inclusion in the review. Overall average retention after 12 months was 54.3% [95% confidence interval (CI)=46.2, 63.7%]. Overall average retention was moderately good for both buprenorphine (48.3%, 95% CI=22.1, 74.6%) and methadone (56.6%, 95% CI=45.9%, 67.3%) after 12 months of treatment. Among programs using methadone there was no statistically significant difference in average retention by dosage level, and the 10 highest and lowest dosage programs obtained similar average retention levels after 12 months. Conclusion: Medication-assisted treatment programs in low- and middle-income countries achieve an average 50% retention rate after 12 months, with wide variation across programs but little difference between those using buprenorphine versus methadone.

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KW - Methadone

KW - Opiate abuse

KW - Opiate substitution programs

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