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Retention of participants in medication‐assisted programs in low‐ and middle‐income countries: an international systematic review
Author(s) -
Feelemyer Jonathan,
Des Jarlais Don,
Arasteh Kamyar,
AbdulQuader Abu S.,
Hagan Holly
Publication year - 2014
Publication title -
addiction
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.424
H-Index - 193
eISSN - 1360-0443
pISSN - 0965-2140
DOI - 10.1111/add.12303
Subject(s) - buprenorphine , methadone , retention rate , medicine , confidence interval , opiate , psychiatry , opioid , receptor , computer security , computer science
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 P referred R eporting I tems for S ystematic R eviews and M eta‐ A nalyses ( 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 27 047 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.