Factors associated with relapse into drug use among male and female attendees of a three-month drug detoxification–rehabilitation programme in Dhaka, Bangladesh: a prospective cohort study

Harm Reduction Journal

Tasnim Azim²  Noboru Takamura⁶  Sonia Afrin³  Iqbal Masud⁴  Tarun Kanti Gayen⁵  Ronald Drahozal¹  Masud Reza²  Ezazul Islam Chowdhury²  Yuki Maehira⁶ 

[1] Ashokti Punorbashon Nibash (APON), 9/7 Iqbal Road Mohammadpur, Dhaka 1207, Bangladesh;International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh;CARE Bangladesh, 20-21 Kawran Bazar, Dhaka 1215, Bangladesh;Dhaka Ahsania Mission (DAM), Dhanmondi R/A, Dhaka 1209, Bangladesh;The Society for Community Health, Rehabilitation, Education and Awareness (CREA), 1/14 Iqbal Road, Mohammadpur, Dhaka 1207, Bangladesh;Department of Global Health, Medicine and Welfare Atomic Bomb Disease Institute, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan

关键词: Bangladesh;    People who use drugs;    Drug detoxification-rehabilitation;    Gender;    Relapse;   

Others  :  809870
DOI  :  10.1186/1477-7517-10-14

 received in 2012-02-02, accepted in 2013-08-29,  发布年份 2013

【 摘 要 】

Background

To determine relapse rates and associated factors among people who use drugs (PWUDs) attending abstinence-oriented drug treatment clinics in Dhaka, Bangladesh.

Methods

A cohort of male and female PWUDs admitted to the 3-month drug detoxification-rehabilitation treatment programmes of three non-governmental organisation-run drug treatment clinics in Dhaka, Bangladesh were interviewed on admission and over the following 5 months, which included the first 2 months after discharge. The study subjects comprised 150 male and 110 female PWUDs who had been taking opiates/opioids, cannabis or other drugs (including sedatives) before admission, had provided informed consent and were aged ≥16 years. Interviews were conducted using semi-structured questionnaires at four time points; on admission, at discharge and at 1 and 2 months after discharge. Relapse rates were assessed by the Kaplan–Meier method. Factors associated with relapse on enrolment and after discharge were determined using the Cox proportional hazards regression model.

Results

A greater proportion of female than male subjects relapsed over the study period (71.9% versus 54.5%, p < 0.01). For men, baseline factors associated with relapse were living with other PWUDs (relative hazard ratio [RHR] = 2.27), living alone (RHR = 2.35) and not having sex with non-commercial partners (RHR = 2.27); whereas for women these were previous history of drug treatment (RHR = 1.94), unstable housing (RHR = 2.44), higher earnings (RHR = 1.89), preferring to smoke heroin (RHR = 3.62) and injecting buprenorphine/pethidine (RHR = 3.00). After discharge, relapse for men was associated with unstable housing (RHR = 2.78), living alone (RHR = 3.69), higher earnings (RHR = 2.48) and buying sex from sex workers (RHR = 2.29). Women’ relapses were associated with not having children to support (RHR = 3.24) and selling sex (RHR = 2.56).

Conclusions

The relapse rate was higher for female PWUDs. For both male and female subjects the findings highlight the importance of stable living conditions. Additionally, female PWUDs need gender-sensitive services and active efforts to refer them for opioid substitution therapy, which should not be restricted only to people who inject drugs.

【 授权许可】

   
2013 Maehira et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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