Demographic Characteristics
Respondents’ average age is 33.3 years (ranging from 20 to 76 years). Majority of the respondents were male 98.6% and 1.4% were female. As the majority, 209 took methadone daily from the methadone dispensing sites and 1 (0.48%) had take-home dose and all reported their history of opioid abuse. Majority of methadone patients are their first time of treatment for methadone 173 (83%) and getting more than one time treatment is 35 (17%) and treatment frequency of methadone ranges from 1 to 6 times. The average methadone dose is 83mg (with a range of 20mg to 300mg) and their average duration on treatment is 28 months (range: 6 to 127 months). Meanwhile, almost two thirds (63%, n = 132) had methadone dose less than or equal 80mg daily dose while 75 (37%, n = 76) had more than 80mg daily dose. Their average Body Mass Index (BMI) is 20.5 (range from14.0 to 33.3). More than two thirds; 159 (75.57%) had primary through high school education and 45 (21.43%) had college level while only 6 (2.86%) had non-formal education. Almost half; 96 (46.38%) were single/ divorced and 84 (40.58%) were married while 27 (13.04%) were separated. Their historic working status within 3 years showed that the majority; 192 (93.43%) had recent jobs (previous 3-year period) and 18 (8.57%) were in no-job categories (including disabled, students). However, 28 (13.46%) had received their income from the drug negotiation within 30 days. Twenty-nine (13.81%) were working as outreach workers or peer-educators for drug users. The VSSS scale was mentioned based on responses to each question in Table 1.
Table 1
Table shows VSSS-MT Treatment satisfaction scale among respondents
Variable
|
Frequency
(n and %)
|
Mean (SD)
|
Range
|
Verona Service Satisfaction Scale for Methadone-Treatment (VSSS-MT) scale
Not much satisfied
Much satisfied
|
209 (100%)
23 (11%)
186 (89%)
|
100.22 (14.19)
|
58–131
|
VSSS Item Categories
Professional Skills Items
Basic Interventions Items
Specific Interventions Items
|
209
209
209
|
3.89 (0.64)
3.83 (0.54)
3.42 (0.68)
|
1.5-5
2.3-5
1.5–4.9
|
VSSS Items Description
|
|
|
|
1. Helping patient deal with problem
|
209
|
3.77 (0.96)
|
|
2. Doctors’ ability to listen
|
208
|
3.97 (0.83)
|
|
3. Psychologists’ ability to listen
|
206
|
3.99 (0.86)
|
|
4. Doctors’ manner
|
208
|
3.92 (0.84)
|
|
5. Psychologists’ manner
|
204
|
4.02 (0.77)
|
|
6. Referring to other specialists
|
201
|
3.76 (0.87)
|
|
7. Overall satisfaction
|
208
|
4.22 (0.76)
|
|
8. Nurses’ manner
|
209
|
3.91 (0.84)
|
|
9. Social workers’ manner
|
205
|
3.73 (1.00)
|
|
10. Improving relationship between patient and relatives
|
208
|
4.00 (0.84)
|
|
11. Helping family members to understand patient’s problems
|
209
|
4.01 (0.81)
|
|
12. Nurses’ knowledge of patient’s medical history
|
209
|
3.78 (0.94)
|
|
13. Information on addiction
|
209
|
3.72(0.93)
|
|
14. Helping patient in relationships outside the family
|
209
|
3.44 (1.04)
|
|
15. Instructions between visits
|
209
|
3.79 (0.85)
|
|
16. Helping patient to look after himself
|
209
|
3.98 (0.77)
|
|
17. Nurses’ ability to listen
|
208
|
3.83 (0.84)
|
|
18. Social workers’ ability to listen
|
209
|
3.75 (0.92)
|
|
19. Help received for methadone side effects
|
207
|
3.88 (0.85)
|
|
20. Individual rehabilitation
|
209
|
3.64 (1.07)
|
|
21. Individual psychotherapy
|
209
|
3.67 (1.05)
|
|
22. Family therapy
|
208
|
4.19 (0.81)
|
|
23. Activities organised by centre
|
209
|
3.82 (0.97)
|
|
24. Group psychotherapy
|
209
|
3.33 (1.06)
|
|
25. Sheltered work
|
208
|
3.03 (1.23)
|
|
26. Help by the centre at home
|
204
|
2.51 (1.27)
|
|
27. Help to join in activities separate from the centre
|
209
|
3.16 (1.17)
|
|
Treatment satisfaction rating differed with study sites, lower in the big cities (Yangon, Mandalay) and higher in the small cities (Kawlin, Lashio and Mohnyin). Satisfaction with methadone service (VSSS-MT score) was reported as 100 for average and ranging from 58 to 131 whereas over 80 as “much satisfaction”; rated 3 above Likert scale of 5 for all questionnaires. A total of 88.57% (n = 186) were “much satisfied” with methadone service. However, VSSS-MT score rated professional skill items (doctor, nurse, counsellor and worker) as 3.89 out of 5, basic intervention items as 3.83 and specific intervention items as 3.42. Those on high methadone dose with more than 80mg gave higher satisfaction rating than low dose personnel (p = 0.0276).
Differences of VSSS scales with respondents’ characteristics
There are VSSS domain scale differences with the characteristics of methadone patients as described in Table 2.
Table 2
Table shows total VSSS-MT scale differences by the characteristics of patients
Respondent characters
|
Sub groups
|
Number (n)
|
Total VSSS-MT score
|
p value
|
Methadone dose categories
|
less than or equal 80mg
more than 80mg
|
132
76
|
99
103
|
0.0276**
|
Methadone duration
|
less than or equal 2.4 years more than 2.4 years
|
120
89
|
101
99
|
0.4755
|
Methadone treat time
|
First time treatment
More than first time
|
173
35
|
101
95
|
0.0120**
|
• less than or equal 80mg
|
First time treatment
More than first time
|
109
22
|
100
92
|
0.0091**
|
• more than 80mg
|
First time treatment
More than first time
|
63
13
|
104
100
|
0.4167
|
• less than or equal 2.4 years
|
First time treatment
More than first time
|
95
24
|
103
94
|
0.0052
|
• more than 2.4 years
|
First time treatment
More than first time
|
78
11
|
100
97
|
0.6067
|
HIV status (HIV)
|
Not infected
Infected
|
126
74
|
99
102
|
0.1351
|
Hepatitis C status (HCV)
|
Not infected
Infected
|
77
71
|
103
99
|
0.0452**
|
Hepatitis B status (HBV)
|
Not infected
Infected
|
166
15
|
101
102
|
0.8754
|
Tuberculosis (TB) treatment history
|
Not treated
treated
|
147
54
|
101
101
|
0.9021
|
Sexually Transmitted infection (STI) history
|
Not infected
Infected
|
164
45
|
100
101
|
0.7577
|
Age
|
Younger and equal 35 years
Older than 35 years
|
128
81
|
101
99
|
0.4433
|
Body Mass Index (BMI)
|
Less than mean BMI (20.5)
More than mean BMI
|
122
84
|
100
100
|
0.9412
|
Currently on antiretroviral therapy (ART)
|
No
On treatment
|
141
68
|
99
103
|
0.0938
|
Education
|
Up to primary
More than primary
|
48
161
|
105
99
|
0.0110**
|
Recent work
|
Unemployed
Employed
|
24
182
|
97
101
|
0.1926
|
Current Peer/ Outreach
|
No
Peer/outreach
|
180
29
|
101
98
|
0.4528
|
ASI for Employment
|
Low score
High score
|
102
104
|
99
101
|
0.4711
|
ASI for Alcohol Use
|
Low score
High score
|
28
36
|
106
102
|
0.2600
|
ASI for Drug Use
|
Low score
High score
|
162
47
|
101
98
|
0.1604
|
ASI for Legal Status
|
Low score
High score
|
14
14
|
102
94
|
0.1590
|
ASI for Family/ Social Status
|
Low score
High score
|
139
70
|
101
99
|
0.3306
|
Marital status
|
Currently married
Single/separated
|
84
122
|
99
101
|
0.1568
|
Income
|
Lower (than average)
Higher
|
131
77
|
100
101
|
0.4542
|
Current marital status satisfaction
|
Not satisfied
Satisfied
|
20
189
|
97
101
|
0.2375
|
WHO Quality of life (QOL) total score
|
Low
High
|
88
121
|
94
105
|
0.0000***
|
Physical QOL score
|
Low
High
|
53
156
|
89
104
|
0.0000***
|
Psychological QOL score
|
Low
High
|
41
168
|
91
102
|
0.0000***
|
Social QOL score
|
Low
High
|
71
138
|
95
103
|
0.0001***
|
Environmental QOL score
|
Low
High
|
54
155
|
91
103
|
0.0000***
|
Current leisure status satisfaction
|
Not satisfied
Satisfied
|
29
180
|
92
101
|
0.0012**
|
• Current leisure status with family
|
Not satisfied
Satisfied
|
119
90
|
100
100
|
0.8200
|
• Current leisure status with friend
|
Not satisfied
Satisfied
|
135
74
|
100
102
|
0.3354
|
• Current leisure status alone
|
Not satisfied
Satisfied
|
159
50
|
101
97
|
0.1123
|
Abuse encountered within 30 days
|
|
|
|
|
• Psychological abuse
|
Not experienced
Experienced
|
183
22
|
100
101
|
0.7474
|
• Physical abuse
|
Not experienced
Experienced
|
203
1
|
100
102
|
.
|
• Sexual abuse
|
Not experienced
Experienced
|
204
1
|
100
111
|
.
|
Urine illicit drug findings
|
|
|
|
|
• Urine Morphine
|
Absent
Present
|
93
116
|
101
100
|
0.7137
|
• Urine Tetrahydrocannabinol (THC)
|
Absent
Present
|
185
24
|
100
99
|
0.5802
|
• Urine Methamphetamine
|
Absent
Present
|
158
51
|
101
98
|
0.2034
|
• Urine Amphetamine
|
Absent
Present
|
191
18
|
100
101
|
0.9167
|
• Urine Benzodiazepine
|
Absent
Present
|
137
72
|
101
99
|
0.3853
|
Last heroin injection within 30 days
|
No
Yes
|
93
115
|
102
98
|
0.0483**
|
Frequency of injection
|
No or few inj: (mean = 7)
Higher
|
96
112
|
102
98
|
0.0373**
|
Needle sharing within 30 days
|
Not shared
Shared
|
99
4
|
99
102
|
0.7169
|
Life time sharing of needle and syringes
|
Not shared
Shared
|
106
102
|
99
102
|
0.1452
|
Independent t-test p value: ** significance < 0.05, *** significance < 0.001 |
Among the different characteristics of the respondents, higher quality of life on physical, psychological, social and environmental categories, respondents who satisfied on current marital status and current leisure status, respondents who were on alcohol were associated with higher treatment satisfaction on methadone, over 80 as “much satisfaction”; (p < 0.05) as mentioned in Graph 1.
Stepwise regression analysis
After considering significant associated characteristics in the model affecting to the VSSS service satisfaction scale, stepwise binary logistic regression was done among the significant parameters in the model to identify final predictors to the outcome group for “VSSS service satisfaction scale” in Table 3.
Table 3
Table shows correlates of VSSS scale from stepwise regression
Variable
|
Adjusted Odds Ratio (aOR) (95% CI)
|
p value
|
Alcohol
|
5.57 (1.2, 25.88)
|
0.029**
|
Physical quality of life (QOL) score
|
11.87 (4.29, 32.84)
|
0.000***
|
Stepwise binary logistic regression, p value: **significance < 0.05, ***significance < 0.001 |
Retention in logistic regression was predicted the associated characteristics which impacted on the VSSS service satisfaction scale.
In the analysis of binary logistic regression, this analysis estimated the association of independent variables to the outcome variable of VSSS service satisfaction scale category of the methadone patients after controlling the potential confounding variables for adjustment. Alcohol alone had 6 times (aOR 5.57, 95% CI; 1.20- 25.88, p = 0.029) while respondents in good physical health (with higher score in physical quality of life) had 12 times (aOR 11.87, 95% CI; 4.29–32.84, P = 0.000) in contributing to the high VSSS service satisfaction scale. When checking for the multi collinearity, mean variance inflation factor (vif) was 1.61 and none of the variable has more than 10. The regression model alpha ratio is set at 0.05.
Reported Infection status of the patients
Among the methadone respondents, just above one-third (36.5%, n = 76) received high-dose (more than 80mg/ day) and the rest 63.5% (n = 132) received low-dose on methadone (less than 80mg/ day). Almost half of the respondents reported hepatitis C virus infection (HCV) (47%, n = 71/ 148), 37% reported Human Immunodeficiency Virus (HIV) infection (n = 74/ 200), while 16% (n = 34) reported HIV and HCV co-infection. Forty-five (21.53%) reported that they experienced sexually transmitted infections and Hepatitis B infection by 15 (8.29%). Among HIV infected respondents, 68 (92%) were on antiretroviral therapy (ART) and their average ART duration was 30-months (range: 1 to 132 months). In Myanmar, the most commonly prescribed antiretroviral regimen is the combination of tenofovir, emtricitabine and efavirenz which account for 86% which requires a significant methadone dose adjustment. More than 80mg of high methadone dose is associated with taking antiretroviral therapy (p = 0.039).
Treatment satisfaction by methadone dose and infection status
Based on the available cross-sectional data, treatment satisfaction was trying to estimate with cox proportional hazard model assuming the model of in the way of cohort data. Based on estimated model on HIV infection, treatment satisfaction was 2 times higher among HIV negative compared to HIV positive patients after controlling the methadone dose variable (IRR = 0.49, p = 0.000). Similarly for co-infection status (HIV and HCV), satisfaction was 1.7 times higher among non-co-infected patients than co-infected patients (IRR = 0.59, p = 0.000).
Higher rate of satisfaction incidence was 1.49% among HIV negative respondents and 0.72% among HIV positive respondents after adjusting for methadone dose (p = 0.000). Higher dose was associated with increased satisfaction scales (p = 0.037) in HIV negative respondents.
Difference of higher satisfaction incidence was showed in 1.2% among non-co-infected patients and 0.71% among co-infected patients with adjusted doses. Co-infected patients were less likely to get satisfaction compared to non-co-infected patients (p = 0.000).