Predictors of outcome in methadone programs : effect of HIV counseling and testing

OBJECTIVE: To identify predictors of treatment outcomes in methadone maintenance programs and to determine whether HIV counseling and testing influenced these outcomes. DESIGN: Retrospective record review. SETTING: Four methadone maintenance programs in four cities in Connecticut, USA. PARTICIPANTS: Five hundred and ninety-four clients, who began treatment over an 18-month period and for whom records were available, took part. INTERVENTIONS: HIV counseling and testing. MAIN OUTCOME MEASURES: Risk of treatment discontinuation and persistent in-treatment illicit drug use. RESULTS: The most important predictor of treatment discontinuation and of persistent in-treatment illicit drug use was self-reported pre-treatment cocaine use. After controlling for this and demographic risk factors, clients who received initial HIV counseling, when compared with clients who did not, had a similar 12-month discontinuation risk (54 versus 59%; P = 0.08) but were less likely to show persistent illicit drug use (46 versus 53%; P = 0.01). Among counseled entrants who were tested for HIV antibodies, those receiving positive results had a 12-month discontinuation risk similar to those receiving negative results (50 versus 52%), but more often showed persistent illicit drug use (57 versus 44%), although this difference may have been due to chance (P = 0.28). The majority of clients who discontinued treatment did so because they were discharged for non-compliance with clinic rules, usually for failing to pay fees. CONCLUSIONS: HIV counseling and testing do not have a substantial adverse effect on methadone treatment outcomes. In the clinics under study, failure to pay clinic fees was an important factor contributing to discontinuation of treatment.