Abstract: WITHDRAWN: Prevention Programs on Drugs and AIDS in Indonesia: From Research to Practice and Policy (Society for Prevention Research 27th Annual Meeting)

04 WITHDRAWN: Prevention Programs on Drugs and AIDS in Indonesia: From Research to Practice and Policy

Tuesday, May 28, 2019
Pacific D/L (Hyatt Regency San Francisco)
* noted as presenting author
Adhi Wibowo Nurhidayat, MD, Psychiatrist, Soeharto Heerdjan Mental Hospital -Indonesia, Jakarta, Indonesia
Purpose:There is an estimated 4.1 million drug users in Indonesia. The most popular drugs are cannabis (0.71%), followed by methamphetamine (0.38%), MDMA (0.30%), heroin (0.18%).The AIDS epidemic in Indonesia started in the mid 1990’s. The estimated recent number of people living with HIV in Indonesia is 668,498 In September 2015, 184,929 people had been confirmed to be living with HIV infection and 68,197 had been diagnosed with AIDS.
Methadone (MMT) started in 2006 as a national program. MMT is currently available in 87 clinics (including 9 prisons), serving 2,548 patients.In this study, we want to assess the impact of structured counseling on one year retention in MMT, drug use, and risk behaviors.
Methods: Patients from 5 MMT clinics in Jakarta were recruited and randomly assigned to receive either MMT as usual (TAU) or MMT plus Behavioral Drug and Risk Counseling (BDRC). Participants were assessed at baseline, month 6, and month 12. Primary outcome was retention in MMT, and secondary outcomes were continued drug use and HIV risk behaviors. All analyses were performed using an intention-to-treat approach.
Summary: A total of 276 MMT patients were enrolled in the study. The majority of the patients were male (89.9%) with a mean age of 31.6 (SD=5.1) years. BDRC patients participated in a mean of 9 out of the planned 18 BDRC sessions.
At month 6 of this study, 248 of the 276 patients (89.9%) were in MMT, 21 were lost to follow-up (7.6%), and seven were dead (2.5%). At 12 months follow-up, 253 of the 276 patients (91.7%) were in MMT, 12 were lost to follow-up (4.3%), and 11 were dead (4.0%). A number of patients lost to follow-up at month 6, returned to MMT between month 6 and month 12. There was no significant difference in MMT retention between the two treatment conditions at month 12: BDRC 92.0% versus TAU 87.5% (time by treatment interaction: p=0.446).
Drug-related risk behaviors declined over time in both treatment conditions with no significant time by treatment interaction (p=0.975). However, for sexual risk behaviors, the interaction of time by treatment approached significance (p=0.072), indicating a possible beneficial effect of BDRC over TAU.
Compared to TAU, established MMT patients who were assigned to the BDRC group did not demonstrate significantly higher rates of retention or lower rates of opiate use or risk behaviors.
Both groups had high rates of retention and relatively low rates of opiate use and risk behaviors. The counseling participation data from this study suggest that this approach was not accessible or acceptable to patients already engaged in MMT. Improved and more efficient strategies for counseling delivery are needed to expand addiction treatment.
In Indonesia, methadone programs shows how research could be implemented in prevention programs by changing of government policy.
The study was supported by NIDA grant R01 DA026344 and registered at ClinicalTrials.gov with identifier number NCT01360463.
Keywords: prevention;drugs; AIDS; Indonesia