簡易檢索 / 詳目顯示

研究生: 林偉霖
Wei-Lin Lin
論文名稱: 使用海洛因與安非他命之愛滋感染者在美沙冬與HAART之順從性研究
A study of methadone maintenance treatment and HAART adherence amongst HIV infected heroin and amphetamine users.
指導教授: 李思賢
Lee, Szu-Hsien
學位類別: 碩士
Master
系所名稱: 健康促進與衛生教育學系
Department of Health Promotion and Health Education
論文出版年: 2015
畢業學年度: 103
語文別: 中文
論文頁數: 64
中文關鍵詞: 存活分析美沙冬療法服藥順從性雞尾酒療法藥癮愛滋感染者
英文關鍵詞: Highly active antiretroviral therapy, Injecting-drug users, Medical adherence, Methadone maintenance therapy, Survival analysis
DOI URL: https://doi.org/10.6345/NTNU202205586
論文種類: 學術論文
相關次數: 點閱:424下載:74
分享至:
查詢本校圖書館目錄 查詢臺灣博碩士論文知識加值系統 勘誤回報
  • 本研究之目的為了解藥癮愛滋感染者在美沙冬治療與雞尾酒療法之服藥順從情形,並探討美沙冬治療是否提升研究對象雞尾酒療法之順從性。本研究採用衛生福利部疾病管制署次級資料,分析2007-2012年之間感染愛滋病毒且發展出AIDS之藥癮者,並藉由卡方、t-test、二元羅吉斯回歸分析背景變項與HIV/AIDS事件的關係,此事件定義係依研究對象CD4高低分為兩組;而存活分析則解釋藥物組別(兩者皆參加、兩者皆未參加、僅參加美沙冬療法、僅參加雞尾酒療法)與HIV/AIDS感染天數之關係,該感染天數定義為自感染HIV至發展出AIDS之天數,最後分析美沙冬參與天數與美沙冬及雞尾酒療法服藥順從性之關係。
    本研究共分析258人,結果顯示婚姻狀態與發展出HIV/AIDS有顯著差異;存活分析部分,HIV感染天數越長與不同藥物治療組別有相關,而參與美沙冬天數、美沙冬服藥順從性及雞尾酒療法服藥順從性有相關。本研究建議醫療院所相關人員應減少個案對於愛滋感染的疑慮以及增加個案對於藥癮問題的認識,此外當個案對於美沙冬有所疑慮時應立即給予釐清,並且給予個案正向鼓勵以增強其服藥順從性。

    In this study is examine whether methadone maintenance therapy (MMT) increased highly active antiretroviral therapy (HAART) adherence among a cohort of HIV-infected injection drug users (IDUs) and who is develop AIDS . We obtained demographic, MMT and HAART taking history from the Taiwan Centers for Disease Control (Taiwan CDC). There were 258 IDUs participants who accessed MMT from 2007-2012. We using Cox proportional hazards regression to examine the independent associations between MMT taking days and the HAART adherence; MMT adherence.
    Our finding is engagement in MMT was positively associated with HAART adherence (b=0.006, 95% CI: 1.001-1.010, p<.05), but negatively associated with MMT adherence (b=-0.33, 95% CI: 9.57-.978, p<.001). These results is that engagement in MMT can benefit against ART discontinuation. We suggestion the medical institutions personnel give IDUs encouragement to enhance medication adherence.

    致謝 I 摘要 II Abstract III 目錄 IV 表目次 VII 圖目次 VIII 第一章 緒論 1 第一節 研究背景 1 第二節 研究動機 4 第三節 研究目的 6 第四節 研究假設 6 第五節 名詞解釋 7 第二章 文獻探討 9 第一節 感染人類免疫缺乏病毒之現況 9 第二節 藥物濫用現況 15 第三節 愛滋感染與藥物濫用之相關研究 21 第四節 美沙冬療法與注射藥癮者之關係 22 第五節 高效能抗反轉錄病毒療法與愛滋感染者相關研究 26 第六節 高效能抗病毒療法和美沙冬療法與藥癮者相關研究 30 第七節 小結 31 第三章 研究材料與方法 32 第一節 理論基礎 32 第二節 研究架構 34 第三節 研究對象 35 第四節 研究工具 35 第五節 研究倫理考量 35 第六節 相關變項操作定義 36 第七節 研究資料處理 39 第四章 研究結果 40 第一節 背景變項與藥物治療相關變項現況 40 第二節 背景變項與HIV/AIDS事件差異分析 43 第三節 治療組別與HIV/AIDS事件差異分析 45 第四節 存活分析 46 第五章 結果討論 48 第一節 不同藥物組別與HIV/AIDS發病進程之相關性 48 第二節 美沙冬服藥天數與雞尾酒療法順從性之相關性 49 第六章 結論與建議 51 第一節 結論 51 第二節 研究建議 52 第三節 研究限制 53 參考文獻 54 附錄一 個案篩選流程 62 附錄二 研究倫理通過證明函 63 附錄三 各資料庫所提供研究相關變項清單 64

    《中文文獻》
    李思賢 (2008)。 減少傷害緣起與思維:以美沙冬療法做為防制愛滋感染、減少犯罪與海洛因戒治之策略。刑事政策與犯罪研究論文集, 11,頁 89-109。
    林式穀(2004)。海洛因的健康影響。臺北市:國家衛生研究院。
    梁昭華、林慧姿、柯靜芬、李永盛、楊世仰、林頂 (2007)。 台灣東部HIV感染者及AIDS發病者流行病學分析。疫情報導, 23(10),頁 561-574。
    黃彥芳、黃逸芯、潘力誠、謝雅汶、林重賢、王素華等人 (2005)。 台灣2003年底15-49歲愛滋病毒感染估計盛行率[An Estimated Prevalence Rate of Adult (15-49) HIV Infection in Taiwan till Year 2003]。臺灣醫學, 9(6),頁 713-721。
    楊士隆、戴伸峰、曾淑萍 (2011)。 台灣成人受刑人入獄前非法藥物使用之盛行率調查[National Survey of High Risk Groups Illegal Drug Using Prevalence among Adult Inmates In Taiwan]。犯罪學期刊, 14(2),頁 99-137。
    葛應欽 (1988)。 台灣南部地區之人類免疫缺乏病毒感染血清流行病學監測報告。疫情報導, 4。
    葛應欽 (1992)。 台灣人類免疫缺乏病毒(HIV)感染率及發生率初步估計。疫情報導, 8。
    葛應欽、潘碧珍、余幸司、林貴香、王致皓、蔡米山等人 (1988)。 Epidemiological Surveillance of Human Immunodeficiency Virus Infection in Southern Taiwan[以流行病學監測人類免疫缺乏病毒感染與後天免疫缺乏症候群]。The Kaohsiung Journal of Medical Sciences, 4(12),頁 667-676。
    衛生福利部食品藥物管理署(2013)。 102年8月藥物用案件暨檢驗統計資料。取自 https://consumer.fda.gov.tw/Pages/List.aspx?nodeID=606
    衛生福利部疾病管制署(2013a)。 1984-2012年台灣地區本國籍感染人類免疫缺乏病毒者依危險因子統計表。取自 http://www.cdc.gov.tw/professional/info.aspx?treeid=3f2310b85436188d&nowtreeid=2285b9745a0a3cbb&tid=5250BA9AD485D6C3
    衛生福利部疾病管制署(2013b)。愛滋病檢驗及治療指引(第四版)。臺北市:疾病管制署。
    衛生福利部疾病管制署(2015)。 104年1月HIV/AIDS統計月報表。取自 http://www.cdc.gov.tw/professional/downloadfile.aspx?fid=A02E0B8E1280FD93
    衛生福利部疾病管制署(2014)。愛滋病防治工作手冊(第三版)。臺北市:衛生福利部疾病管制署。

    《英文文獻》
    Aceijas, C., Stimson, G. V, Hickman, M., Rhodes, T., Prevention, on behalf of the U. N. R. G. on H., Developing, C. among I. D. U. in, & Countries, T. (2004). Global overview of injecting drug use and HIV infection among injecting drug users. Acquired Immune Deficiency Syndrome, 18(17), 2295–2303.
    Avants, S. K., Margolin, A., Sindelar, J. L., Rounsaville, B. J., Schottenfeld, R., Stine, S., … Kosten, T. R. (1999). Day treatment versus enhanced standard methadone services for opioid-dependent patients: a comparison of clinical efficacy and cost. The American Journal of Psychiatry, 156(1), 27–33.
    Ball, J. C., Lange, W. R., Myers, C. P., & Friedman, S. R. (1988). Reducing the Risk of AIDS Through Methadone Maintenance Treatment. Journal of Health and Social Behavior, 29(3), 214–226. doi:10.2307/2137033
    Ball, J. C., & Ross, A. (1991). The Effectiveness of Methadone Maintenance Treatment: Patients, Programs, Services, and Outcome. SPRINGER VERLAG GMBH. Retrieved from http://books.google.com.tw/books?id=zCZsAAAAMAAJ
    Bangsberg, D. R. (2006). Less than 95% adherence to nonnucleoside reverse-transcriptase inhibitor therapy can lead to viral suppression. Clin Infect Dis, 43(7), 939–941. doi:10.1086/507526
    Bangsberg, D. R., Hecht, F. M., Charlebois, E. D., Zolopa, A. R., Holodniy, M., Sheiner, L., … Moss, A. (2000). Adherence to protease inhibitors, HIV-1 viral load, and development of drug resistance in an indigent population. AIDS, 14(4), 357–366.
    Blix, O., & Grönbladh, L. (1991). The Impact of Methadone Maintenance Treatment on the Spread of HIV Among IV Heroin Addicts in Sweden. In N. Loimer, R. Schmid, & A. Springer (Eds.), Drug Addiction and AIDS (pp. 200–205). Springer Vienna. doi:10.1007/978-3-7091-9173-6_22
    Booth, R. E., Crowley, T. J., & Zhang, Y. (1996). Substance abuse treatment entry, retention and effectiveness: out-of-treatment opiate injection drug users. Drug and Alcohol Dependence, 42(1), 11–20. doi:http://dx.doi.org/10.1016/0376-8716(96)01257-4
    Burns, L., & Teesson, M. (2002). Alcohol use disorders comorbid with anxiety, depression and drug use disorders. Drug and Alcohol Dependence, 68(3), 299–307. Retrieved from http://www.sciencedirect.com/science/article/pii/S037687160200220X
    Caplehorn, J. R., & Ross, M. W. (1995). Methadone maintenance and the likelihood of risky needle-sharing. Int J Addict, 30(6), 685–698.
    Clarke, S. M., & Mulcahy, F. M. (2000). Antiretroviral therapy for drug users. Int J STD AIDS, 11(10), 627–631.
    Detels, R., Muñoz, A., McFarlane, G., & et al. (1998). EFfectiveness of potent antiretroviral therapy on time to aids and death in men with known hiv infection duration. JAMA, 280(17), 1497–1503. doi:10.1001/jama.280.17.1497
    Drug. (2010). In Encyclopedia student Britannica. Encyclopedia Britannica, Inc.
    Edelman, E. J., Cheng, D. M., Krupitsky, E. M., Bridden, C., Quinn, E., Walley, A. Y., … Samet, J. H. (2014). Heroin Use and HIV Disease Progression: Results from a Pilot Study of a Russian Cohort. AIDS and Behavior. doi:10.1007/s10461-014-0948-z
    Farrell, M., Gowing, L., Marsden, J., Ling, W., & Ali, R. (2005). Effectiveness of drug dependence treatment in HIV prevention. International Journal of Drug Policy, 16, Supple(0), 67–75. doi:http://dx.doi.org/10.1016/j.drugpo.2005.02.008
    Feelemyer, J., Des Jarlais, D., Arasteh, K., & Uusküla, A. (2014). Adherence to Antiretroviral Medications Among Persons Who Inject Drugs in Transitional, Low and Middle Income Countries: An International Systematic Review. AIDS and Behavior. doi:10.1007/s10461-014-0928-3
    Gossop, M., Marsden, J., Stewart, D., & Treacy, S. (2002). Reduced injection risk and sexual risk behaviours after drug misuse treatment: results from the National Treatment Outcome Research Study. AIDS Care, 14(1), 77–93. doi:10.1080/09540120220097955
    Gottheil, E., Weinstein, S. P., Sterling, R. C., Lundy, A., & Serota, R. D. (1998). A randomized controlled study of the effectiveness of intensive outpatient treatment for cocaine dependence. Psychiatr Serv, 49(6), 782–787.
    Gowing, L. R., Farrell, M., Bornemann, R., Sullivan, L. E., & Ali, R. L. (2006). Brief report: Methadone treatment of injecting opioid users for prevention of HIV infection. Journal of General Internal Medicine, 21(2), 193–195. doi:10.1111/j.1525-1497.2005.00287.x
    Hartel, D. M., & Schoenbaum, E. E. (1998). Methadone treatment protects against HIV infection: two decades of experience in the Bronx, New York City. Public Health Rep, 113 Suppl , 107–115.
    Haverkos, H. W. (1998). HIV/AIDS and drug abuse: epidemiology and prevention. J Addict Dis, 17(4), 91–103. doi:10.1300/J069v17n04_08
    Hubbard, R. L., Craddock, S. G., Flynn, P. M., Anderson, J., & Etheridge, R. M. (1997). Overview of 1-year follow-up outcomes in the Drug Abuse Treatment Outcome Study (DATOS). Psychology of Addictive Behaviors, 11(4), 261–278. doi:10.1037/0893-164X.11.4.261
    International Harm ReductionAssociation. (2010). What is harm reduction?A position statement from the International Harm Reduction Association. International Harm ReductionAssociation. Retrieved from http://www.ihra.net/what-is-harm-reduction
    Kwiatkowski, C. F., & Booth, R. E. (2001). Methadone maintenance as HIV risk reduction with street-recruited injecting drug users. J Acquir Immune Defic Syndr, 26(5), 483–489.
    Lawrinson, P., Ali, R., Buavirat, A., Chiamwongpaet, S., Dvoryak, S., Habrat, B., … Zhao, C. (2008). Key findings from the WHO collaborative study on substitution therapy for opioid dependence and HIV/AIDS. Addiction, 103(9), 1484–1492. doi:10.1111/j.1360-0443.2008.02249.x
    Lee, H. C., Ko, N. Y., Lee, N. Y., Chang, C. M., Liu, S. Y., & Ko, W. C. (2010). Trends in sexually transmitted diseases and risky behaviors among HIV-infected patients at an outpatient clinic in southern Taiwan. Sex Transm Dis, 37(2), 86–93. doi:10.1097/OLQ.0b013e3181bd8301
    Lee, T. S., Shen, H. C., Wu, W. H., Huang, C. W., Yen, M. Y., Wang, B. E., … Liu, Y. L. (2011). Clinical characteristics and risk behavior as a function of HIV status among heroin users enrolled in methadone treatment in northern Taiwan. Subst Abuse Treat Prev Policy, 6, 6. doi:10.1186/1747-597x-6-6
    Lucas, G. M., Cheever, L. W., Chaisson, R. E., & Moore, R. D. (2001). Detrimental Effects of Continued Illicit Drug Use on the Treatment of HIV-1 Infection. JAIDS Journal of Acquired Immune Deficiency Syndromes, 27(3), 251–259.
    Lucas, G. M., Gebo, K. A., Chaisson, R. E., & Moore, R. D. (2002). Longitudinal assessment of the effects of drug and alcohol abuse on HIV-1 treatment outcomes in an urban clinic. AIDS, 16(5), 767–774.
    Lyu, S. Y., Su, L. W., & Chen, Y. M. (2012). Effects of education on harm-reduction programmes. Lancet, 379(9814), e28–30. doi:10.1016/s0140-6736(11)60786-1
    McLellan, A. T., Arndt, I. O., Metzger, D. S., Woody, G. E., & O’Brien, C. P. (1993). The effects of psychosocial services in substance abuse treatment. JAMA, 269(15), 1953–1959.
    Metzger, D. S., Navaline, H., & Woody, G. E. (1998). Drug abuse treatment as AIDS prevention. Public Health Rep, 113 Suppl , 97–106.
    Metzger, D. S., Woody, G. E., McLellan, A. T., O’Brien, C. P., Druley, P., Navaline, H., … Abrutyn, E. (1993). Human immunodeficiency virus seroconversion among intravenous drug users in- and out-of-treatment: an 18-month prospective follow-up. J Acquir Immune Defic Syndr, 6(9), 1049–1056.
    Mitchell, S. J., Morris, S. R., Kent, C. K., Stansell, J., & Klausner, J. D. (2006). Methamphetamine use and sexual activity among HIV-infected patients in care--San Francisco, 2004. AIDS Patient Care and STDs, 20(7), 502–10. doi:10.1089/apc.2006.20.502
    Moss, A. R., Vranizan, K., Gorter, R., Bacchetti, P., Watters, J., & Osmond, D. (1994). HIV seroconversion in intravenous drug users in San Francisco, 1985-1990. AIDS, 8(2), 223–231.
    Novick, D. M., Joseph, H., Croxson, T. S., Salsitz, E. A., Wang, G., Richman, B. L., … Whimbey, E. (1990). Absence of antibody to human immunodeficiency virus in long-term, socially rehabilitated methadone maintenance patients. Arch Intern Med, 150(1), 97–99.
    Palella, F. J., Delaney, K. M., Moorman, A. C., Loveless, M. O., Fuhrer, J., Satten, G. A., … Holmberg, S. D. (1998). Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. The New England Journal of Medicine, 338(13), 853–60. doi:10.1056/NEJM199803263381301
    Palepu, A., Tyndall, M. W., Joy, R., Kerr, T., Wood, E., Press, N., … Montaner, J. S. (2006). Antiretroviral adherence and HIV treatment outcomes among HIV/HCV co-infected injection drug users: the role of methadone maintenance therapy. Drug Alcohol Depend, 84(2), 188–194. doi:10.1016/j.drugalcdep.2006.02.003
    Qian, H. Z., Hao, C., Ruan, Y., Cassell, H. M., Chen, K., Qin, G., … Shao, Y. (2008). Impact of methadone on drug use and risky sex in China. J Subst Abuse Treat, 34(4), 391–397. doi:10.1016/j.jsat.2007.07.002
    Reddon, H., Milloy, M.-J., Simo, A., Montaner, J., Wood, E., & Kerr, T. (2014). Methadone maintenance therapy decreases the rate of antiretroviral therapy discontinuation among HIV-positive illicit drug users. AIDS and Behavior, 18(4), 740–6. doi:10.1007/s10461-013-0584-z
    Robert L. Hubbard J. Valley Rachal, Henrick J. Harwood, Elizabeth R. Cavanaugh, and Harold M. Ginzburg., M. E. M. (1989). Drug abuse treatment: a national study of effectiveness. University of North Carolina Press. Retrieved from http://books.google.com.tw/books?id=2ttrAAAAMAAJ
    Russell, K., Dryden, D. M., Liang, Y., Friesen, C., O’Gorman, K., Durec, T., … Klassen, T. P. (2008). Risk factors for methamphetamine use in youth: a systematic review. BMC Pediatrics, 8, 48. doi:10.1186/1471-2431-8-48
    Serpelloni, G., Carrieri, M. P., Rezza, G., Morganti, S., Gomma, M., & Binkin, N. (1994). Methadone treatment as a determinant of HIV risk reduction among injecting drug users: a nested case-control study. AIDS Care, 6(2), 215–220. doi:10.1080/09540129408258632
    Sethi, A. K., Celentano, D. D., Gange, S. J., Moore, R. D., & Gallant, J. E. (2003). Association between adherence to antiretroviral therapy and human immunodeficiency virus drug resistance. Clin Infect Dis, 37(8), 1112–1118. doi:10.1086/378301
    Sorensen, J. L., & Copeland, A. L. (2000). Drug abuse treatment as an HIV prevention strategy: a review. Drug Alcohol Depend, 59(1), 17–31.
    Sullivan, L. E., Metzger, D. S., Fudala, P. J., & Fiellin, D. A. (2005). Decreasing international HIV transmission: the role of expanding access to opioid agonist therapies for injection drug users. Addiction, 100(2), 150–158. doi:10.1111/j.1360-0443.2004.00963.x
    Thiede, H., Hagan, H., & Murrill, C. S. (2000). Methadone treatment and HIV and hepatitis B and C risk reduction among injectors in the Seattle area. J Urban Health, 77(3), 331–345.
    Tony Szu-Hsien Lee. (2006). Sexual Violence Victimization and Condom Use in Relation to Exchange of Sexual Services by Female Methamphetamine Prisoners: An Exploratory Study of HIV Prevention. Taiwan Journal of Public Health, 25(3), 214–222.
    Tony Szu-Hsien Lee, Cheng-Shi Shiu, Yung-Change Tuan, Wei-Hsin Wu, Chun-Wei Huang, Muh-Yong Yen, Chun-Hsiu Lin, L.-C. S. and C.-K. L. (n.d.). Quality of Life among Injection Drug Users Living with or without HIV/AIDS in Taiwan: A Case Control Group Design. Journal of AIDS & Clinical Research. Retrieved from http://www.omicsonline.org/quality-of-life-among-injection-drug-users-living-with-or-without-hiv-aids-in-taiwan-a-case-control-group-design-2155-6113.1000199.php&&aid=12280
    Uhlmann, S., Milloy, M.-J., Kerr, T., Zhang, R., Guillemi, S., Marsh, D., … Wood, E. (2010). Methadone maintenance therapy promotes initiation of antiretroviral therapy among injection drug users. Addiction (Abingdon, England), 105(5), 907–13. doi:10.1111/j.1360-0443.2010.02905.x
    UNAIDS. (2008). Report on the global HIV/AIDS epidemic 2008. Retrieved from http://data.unaids.org/pub/GlobalReport/2008/jc1511_gr08_executivesummary_en.pdf
    UNAIDS. (2010). Global report: UNAIDS report on the global AIDS epidemic 2010. Retrieved from http://www.unaids.org/documents/20101123_globalreport_em.pdf
    UNAIDS. (2011). GLOBAL HIV/AIDS RESPONSE-Epidemic update and health sector progress towards Universal Access-Progress Report 2011. Retrieved from http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2011/20111130_ua_report_en.pdf
    UNAIDS. (2012). Global report: UNAIDS report on the global AIDS epidemic 2012. Retrieved from http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiology/2012/gr2012/20121120_unaids_global_report_2012_with_annexes_en.pdf
    UNAIDS. (2013). AIDS by the numbers. Retrieved from http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2013/JC2571_AIDS_by_the_numbers_en.pdf
    United Nations Office on Drugs and Crime. (2012). World Drug Report 2012. Vienna. Retrieved from http://www.unodc.org/unodc/en/data-and-analysis/WDR-2012.html
    UNODC. (2013). World Drug Report 2013. Retrieved from http://www.unodc.org/wdr/
    Urbina, A., & Jones, K. (2004). Crystal methamphetamine, its analogues, and HIV infection: medical and psychiatric aspects of a new epidemic. Clin Infect Dis, 38(6), 890–894. doi:10.1086/381975
    WHO. (1998). Report on the global HIV/AIDS epidemic – June 1998. Geneva. Retrieved from http://data.unaids.org/pub/Report/1998/19981125_global_epidemic_report_en.pdf
    WHO. (2000). Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV/AIDS). World Health Organization. Retrieved January 11, 2014, from http://www.who.int/health-topics/hiv.htm
    Wood, E., Hogg, R. S., Kerr, T., Palepu, A., Zhang, R., & Montaner, J. S. G. (2005). Impact of accessing methadone on the time to initiating HIV treatment among antiretroviral-naive HIV-infected injection drug users. AIDS, 19(8).

    下載圖示
    QR CODE