Substance Use and Heroin Abstinence Rates Among Patients Enrolled at Medically-assisted Therapy Clinic at Mathari National Teaching and Referral Hospital.

Abstract

Introduction: Several evidence-based assessments have shown that the Methadone Maintenance Treatment (MMT) is beneficial, however, multiple substance use among the patients at the time of enrolment has affected the outcomes of the program. Studies have indicated patients continue to use heroin and other substances while in the program. Aim: This study aimed to determine substance use and heroin abstinence rates among patients attending the Medically-Assisted Therapy Clinic at Mathari National Teaching and Referral Hospital, Nairobi. Method: This was a retrospective cohort study of 713 patients who had enrolled in the MAT clinic between December 2014 and February 2018. Data of each participant was collected over a period of 24 months. This study was a census. A researcher-designed socio-demographic form and data collecting form were used to collect data. Data analysis: Data was entered into MS-Excel and checked for errors before being analyzed with SPSS version 26.0. For discrete variables, frequency tables, pie charts, and bar graphs were provided, while for continuous data, means and standard deviations were provided. Chisquare test was used to analyze the associations between variables at the bivariate level. At the multivariate level, logistic regression analysis was utilized to calculate adjusted odds ratio. The confidence interval was set at 95%, while the statistical significance level was set at p≤ 0.05. Results: There were 713 participants in the study. Most were male 611(85.7%). The mean age was 34.2 years (SD 8.55). The majority had attained primary level of education 333(46.7%), were employed 424(59.47%), and were separated 322(45.1%). All the participants had used at least one other substance apart from heroin. The commonest substances were; tobacco 649(91%), followed by cannabis 591(82.9%) and benzodiazepines 367(51.5%). Tobacco, benzodiazepines, miraa, and benzhexol all had a significant association with various sociodemographic characteristics. At 6, 12, 18, and 24 months, heroin abstinence rates were 61.3%, 76.0%, 73.5%, and 81.4%, respectively. Abstinence rates increased from 61.3% at 6 months to 81.4%at 24 months, which was statistically significant (p<0.001). Conclusion: Majority of the patients attending MAT clinic use more than one substance, therefore, there is a need to scale up the program to also offer free management for other substances. This study replicated the evidence of methadone treatment among heroin users, however, there is still a need to explore further why some patients continue to use heroin while in the program.