Study design, respondents and location
A total of 210 clients receiving methadone treatment participated in this cross-sectional study. All the respondents for this study were recruited through stratified random sampling from five cities (Yangon, Mandalay, Lashio, Kawlin and Mohnyin) in Myanmar where MMT programme is formally implemented. The Addiction Severity Index- Lite (ASI) (McLellan, et al. 1999) was used to objectively determine respondents social-functioning.
Inclusion and exclusion criteria
Inclusion criteria for the study include; 1) must be above 18 years of age, 2) presently enrolled in MMT programme and tested positive for methadone, and 3) must have a minimum of six-months MMT history. We excluded those who hesitate to give their informed consent and those experiencing significant health and psychological problems.
All the study data was collected from May to July 2017. All the surveys were conducted through face-to-face interviews by two trained researchers. A semi-structured questionnaire was used to collect respondents’ socio-demographic characteristics, quality of life information, HIV risk behaviours, previous drug use history, and history on infectious disease and methadone treatment experiences. We also used the validated Addiction Severity Index- Lite (ASI) (McGahan, et al. 1986), WHOQOL-BREF (WHO, The World Health Organization Quality of Life (WHOQOL)-BREF 2004), and Timeline Follow back (TLFB survey) (NIDA-CTN 2014) questionnaires to collect respondents drug use history.
Specifically for Addiction Severity Index (ASI) scores, 5 out of 7 composite scores were collected and analysed for employment, alcohol, drug use, legal status, family/social composite scores except medical and psychiatric composites. Each raw composite score was calculated and transformed to a 0-100 scale using the formula shown below:
where “Actual raw score” is the values achieved through summation of responses from each composite score, “lowest possible raw score” is the lowest possible value that could occur through summation (this value would be 4 for all facets of employment), and “Possible raw score range” is the difference between the maximum possible raw score and the lowest possible raw score.
All the respondents were screened for methadone use prior to their participation in the study. Rapid-test kits were used to confirm the respondents illicit drug use status for Morphine, Cannabis, Methamphetamine, Amphetamine, and Benzodiazepine use.
Composite Score for Employment Status
ASI composite score for employment status was included questions on driver’s license and car availability for their use, paid work in the past 30 days, income from work in the past 30 days. Those responses were combined and transformed to 0-100 scale for comparison among the responses.
Composite Score for Alcohol Use
Composite score for alcohol use was derived from the responses to the questions of number of days of any alcohol use/ intoxication in the past 30 days, number of days troubled or bothered by any alcohol problems, how it was troubled in the past 30 days, how importance of treatment for alcohol problems and money spent during the past 30 days on alcohol. Alcohol related responses were combined and transformed to 0-100 scale for comparison among the responses.
Composite Score for Drug Use
Composite score for drug use was derived from the responses to the questions of number of days use of drugs (Heroin, Methadone, Other opiates/analgesics, Barbiturates, Other sedatives, Cocaine, Amphetamines, Cannabis, Hallucinogens), number of days used more than one drug, number of days experienced drug use problems in the past 30 days, how it was troubled in the past 30 days and how importance of treatment for drug problems. Drug use related responses were combined and transformed to 0-100 scale for comparison among the responses.
Composite Score for Legal Status
Composite score for legal status was derived from the responses to the questions on status of presently awaiting charges, trial, or sentencing, number of days engaged in illegal activity for profit in past 30 days and amount of money received from illegal sources in the past 30 days. Legal status related responses were combined and transformed to 0-100 scale for comparison among the responses.
Composite Score for Family/Social Status
Composite score for family/social status was derived from the responses to the questions on satisfaction with current marital situation, serious conflicts with their family in the past 30 days, family problems troubled or bothered in the past 30 days and importance of treatment or counselling for family problems. Responses were combined and transformed to 0-100 scale for comparison among the responses.
Composite Score for Medical Status and Psychiatric Status
Composite score for medical status and psychiatric status were not included as the exclusion criteria of the respondent “those who couldn’t answer the survey questions due to medical and psychiatric problem were excluded” in the client selection criteria. So, these two sessions in the ASI were omitted.
Use of Statistical tests
The study data was analysed with Stata14.0 software. The responses were summarized and analysed into respective composite scores and total scores. Chi-square test and Fisher’s exact test were used for identifying association of the ASI score differences between categorical variables. For examining the differences between mean ASI scores of the interested parameters, independent sample t-tests were used for analysis. A higher ASI score reflects the worse functioning situation and lower ASI scores reflects the better functioning of the clients. Binary logistic regression was used for identifying the predictors to the interested outcome “ASI total score”. Stepwise binary logistic regression analysis was done to recheck the significant regression output with the intended output by adjusting the confounding associated variables. All outcomes were set with statistically significance at p<0.05 with two-tailed results.
Ethical approval for the study was obtained from the Human Ethics and Research Committee of Universiti Sains Malaysia (No: USM/ JEPeM/16080269) (University of Science, Malaysia) and Department of Medical Research (No: Ethics/DMR/2017/057), Ministry of Health and Sports, Myanmar (Research 2017).