社區(qū)藥物維持治療工作進展報告

1、社區(qū)藥物維持治療工作進展報告Scaling-up the methadone maintenance treatment program in China,UNETG Meeting , 2009.2.25,阿片類物質(zhì)成癮者社區(qū)藥物維持治療國家級工作組/秘書處National Working Group on Community–based Methadone Maintenance Treatment for Opium De

2、pendents,內(nèi)容提要Outlines,我國的艾滋病流行形勢 Update of the HIV/AIDS epidemic in China 社區(qū)藥物維持治療工作的進展 The progress of China’s MMT program 社區(qū)藥物維持治療的效果評估 Evaluation of the MMT program 社區(qū)藥物維持治療的挑戰(zhàn)和應(yīng)對

3、Lessons learned and challenges,,中國艾滋病流行形勢 Update on the HIV/AIDS epidemic in China,艾滋病流行狀況HIV/AIDS epidemic,2007年HIV/AIDS 報告病例Reported HIV/AIDS cases by end of 2007: HIV/AIDS: 230,643 （276,335） AIDS : 66,39

4、2 (82,322) AIDS death : 23,963 (38,150)2007年HIV/AIDS 估計病例數(shù)HIV/AIDS Estimates by end of 2007 : People with HIV/AIDS: 700,000 (550,000-850,000) AIDS cases: 85,000 (80,000-90,000). HIV infection rate: 0.0

5、5 % (0.04-0.07%),Resource: A Joint Assessment of HIV/AIDS Prevention and Care in China(2007) (State Council AIDS Working Committee Office, UN Theme Group on AIDS in China ),,報告HIV/AIDS傳播途徑構(gòu)成(2007)Trans

6、mission mode (2007),Increased sex transmission,Cumulative (Until Aug2007),New reported in 2007 (Jan-Aug,2007),Resource: A Joint Assessment of HIV/AIDS Prevention and Care in China(2007) (State Council A

7、IDS Working Committee Office, UN Theme Group on AIDS in China ),,累計報告,2008年新報告,,報告HIV/AIDS傳播途徑構(gòu)成,報告HIV/AIDS傳播途徑構(gòu)成 (2008) Transmission mode (2008),,Drug Use in 2007,動態(tài)管控系統(tǒng)吸毒人數(shù) Current total drug users :957,00

8、0 海洛因成癮者 Heroin users: 746,460 靜脈吸毒人員 Injecting drug use: 72.5%共用針具 Needle Sharing : 40%,Resource: Annual Report on Drug Control in China, 2008. (China National Narcotics Contr

9、ol Committee) A Joint Assessment of HIV/AIDS Prevention and Care in China(2007) (State Council AIDS Working Committee Office, UN Theme Group on AIDS in China ),,毒品使用類型（2008年）Types of D

10、rugs Used in China,2008,Resource: Annual Report on Drug Control in China, 2008. (China National Narcotics Control Committee),,社區(qū)藥物維持治療工作的進展 The Progress of China’s MMT program,美沙酮維持治療工作：從試點到全面

11、推廣Evolution of China’s MMT Program: Moving from pilot stage to national scale-up,2001年之前，政策倡導(dǎo)與開發(fā) Before 2001: Policy advocation and development 2001-2003年，組織結(jié)構(gòu)的建立，實施方案的制定 2001-2003：Institutional organiza

12、tion and beging protocol formulation 2003年11月-2006年6月: 試點階段 Dec 2003- Jun 2006: MMT pilot phase 自2006年7月: 從試點到全面推廣 Since 2006: From pilot program to national scale-up,,艾滋病防治條例

13、中華人民共和國國務(wù)院令 第 457 號2006年3月1日起施行,第二十七條　 縣級以上人民政府應(yīng)當建立艾滋病防治工作與禁毒工作的協(xié)調(diào)機制，組織有關(guān)部門落實針對吸毒人群的艾滋病防治措施。    省、自治區(qū)、直轄市人民政府衛(wèi)生、公安和藥品監(jiān)督管理部門應(yīng)當互相配合，根據(jù)本行政區(qū)域艾滋病流行和吸毒者的情況，積極穩(wěn)妥地開展對吸毒成癮者的藥物維持治療工作，并有計劃地實施其他干預(yù)措施。,Law Enfor

14、cement,HIV/AIDS Regulation (In effective since March 1, 2006)Article 27. The people’s governments at the county level or above shall coordinate the relevant government sectors in order to implement effective measures f

15、or controlling the epidemic of AIDS. The departments of Health, Public Security and Food and Drug Administration of the people’s governments in Provinces, Autonomous Regions, and Municipalities shall jointly, ba

16、sed on their local situation of drug use and HIV/AIDS epidemic, implement community-based drug-maintenance treatment as well as other effective intervention program for drug users.,,中國遏制與防治艾滋病行動計劃(2006-2010年),（二）具體目標和工作指

17、標。到2007年底實現(xiàn)以下目標有效干預(yù)措施覆蓋當?shù)?0%以上的主要高危人群和流動人口。登記在冊吸毒者500人以上的縣（市)，建立藥物維持治療門診，為40%以上符合條件的吸食阿片類毒品（主要指海洛因）成癮者提供藥物維持治療。到2010年底實現(xiàn)以下目標 有效干預(yù)措施覆蓋當?shù)?0%以上的主要高危人群和流動人口。登記在冊吸毒者500人以上的縣（市)，建立藥物維持治療門診，為70%以上符合條件的吸食阿片類毒品（主要指海洛因）成癮者提供

18、藥物維持治療。,,China’s Action Plan for Controlling HIV/AIDS (2006-2010),Specific Tasks (6) County (city) > 500 registered drug users, By 2007: (in urban) MMT cover > 40% (in rural) NEP cover > 30% By 2010:

19、 (in urban) MMT cover > 70% (in rural) NEP cover > 50%,,組織管理結(jié)構(gòu),國 家 工 作 組,省 級 工 作 組,美沙酮口服液配制單位,美沙酮門診,美沙酮門診,美沙酮門診,美沙酮門診,衛(wèi)生部公安部 國家藥監(jiān)局,衛(wèi)生廳公安廳省級藥監(jiān)局省級疾病預(yù)防控制中心,,,,,,,,,,,,秘 書 處,中國疾病預(yù)防控制中心性艾中心,當?shù)毓ぷ鹘M,,Org

20、anizational Structure,,State MMT Working Group,Provincial MMT Working Group,Methadone Formulation Unit,MMT Clinics,MMT Clinics,MMT Clinics,MMT Clinics,Ministry of HealthMinistry of Public SecurityState FDAChina CDC,D

21、epartment of HealthDepartment of Public SecurityProvincial FDAProvincial CDC,,,,,,,,,,,,Secretariat,Evolution of Implementation Protocol,2003 Inclusion of the MMT program: Clients need to have several failed attempts

22、 to quit using heroin; at least two terms in a detoxification centre; being a registered local resident of the area in which the clinic dislocated; etc.The number of allowable missing treatment days: if an MMT client

23、missed any cumulative 15 days in 90 days they were discharged from the programm.Services provided: relatively limited to administering of methadone,July 2006 Inclusion of the MMT program: Clients no longer need a h

24、istory of detoxification for entry and no longer required to be registered as local residents and a transfer system has been set up to meet the needs of those who are relocating either permanently or temporarily.The nu

25、mber of allowable missing treatment days: must miss seven consecutive days (a rarer event, to be disqualified). Services provided : counseling , HCV testing, ARV referral treatment, condom promotion, peer education,

26、psychosocial supports, etc.,,,,美沙酮維持持治療門診建設(shè)The establishment of MMT clinics,,,,,,美沙酮維持持治療門診建設(shè)The establishment of MMT clinics,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,青海,2,甘肅,21,吉林,2,貴州,54,廣西,56,廣東,50,湖南,48,江西,12,福建,9,浙江,27

27、,江蘇,13,陜西,18,寧夏,3,新疆,27,,四川,36,湖北,37,安徽,,云南,67,北京,9,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,海南,23,重慶,26,上海,9,8,2008,,河南,1,天津,內(nèi)蒙,3,1,山西,3,23個?。ㄗ灾螀^(qū)、直

28、轄市）600個門診,21美沙酮流動車和延伸服藥點21 Mobile MMT Vans,（云南-8輛、四川/貴州/湖南/廣東/新疆-2輛、湖北/重慶/浙江-1輛）（8/Yunnan; 2 each/Sichuan/Guizhou/Hunan/Guangdong/Xinjiang; and 1 each/Hubei/Chongqing/Zejiang),,,美沙酮維持治療門診建設(shè) The growing number of MMT c

29、linics,,維持治療累計和在治人數(shù)Cumulative patients treated versus currently receiving treatment （2004-2008）,,,,2008年社區(qū)藥物維持治療工作進展概況 Overall progress in 2008,,,,08年12月全國社區(qū)藥物維持治療工作進展情況,,The MMT Program implementation at provi

30、ncial –level in 2008,培訓(xùn)和技術(shù)支持Training System and Technical Support,門診專業(yè)人員培訓(xùn) Training of MMT treatment and management personnel 門診后期綜合干預(yù)培訓(xùn) Training of comprehensive intervention and care personnel門診開診現(xiàn)場技術(shù)

31、指導(dǎo) On-site support for clinic initiation,,數(shù)字化管理和網(wǎng)絡(luò)化建設(shè)Establishment of MMT database system,臨床管理軟件：Clinical MMT management software 實時和定時統(tǒng)計系統(tǒng)　Real-time and fixed-time reporting system 定期隨訪和跟蹤系統(tǒng)　Follow-up and mon

32、itoring system 實驗室檢測管理系統(tǒng)　Lab-based management system Transferring/ referral system 　異地服藥和轉(zhuǎn)診系統(tǒng)智能IC卡管理系統(tǒng)Intelligent card-system (IC card),,,咨詢 Council ling,小組活動 Group Activity,同伴教育 Peer Education,激勵機制 Incen

33、tive,社區(qū)藥物維持治療效果評估Evaluation of the MMT Program,社區(qū)美沙酮維持治療三年效果評估結(jié)果（1）Evaluation of MMT Program (1),500個門診對禁毒防艾工作的影響The impact of 500 MMT clinics on drug control and HIV/AIDS intervention,,,測量依據(jù)　（Estimation）　　截至2008年12

34、月30 (By 30 Dec 2008), 累計治療 (Those cumulative patients): 178684，目前在治人數(shù)( currently receiving treatment) 93773，平均每門診治療人數(shù)（average of currently receiving treatment /clinic ）156，年保持率（Annual retention rate）69.5％。參數(shù)：（Parameter

35、s）：　　社區(qū)吸毒者艾滋病新發(fā)感染率 (The new infection among IDUs in community)5%、人均日使用海洛因 (The average use of heroin/day) 0.6g/d、海洛因價格（The price of Heroin） 370 RMB/g ，MMT門診(MMT clinics) 500 ，平均每門診治療人數(shù)(The average of those on-treatment/

36、clinics )150 ，治療(Totally treated )75000。,500個門診對禁毒防艾工作的影響The impact of 500 MMT clinics on drug control and HIV/AIDS prevention,保守估計 Conservative Estimation 一年減少新發(fā)艾滋病感染3377人(未包括二代性傳播)　　　Reduced new infections by 3

37、377 annually　　(Exclude secondary transmission )一年可減少海洛因消耗16,425公斤，約16.5噸　　Reduced heroin consumption by 16.425 kg, 　　approx 16.5 ton annually.一年可減少毒資交易60.77億元　　Reduced drug trade 607.7 Billion RMB annually.,,地震中的

38、門診和服藥人員 MMT clinics and clients during the aftershocks,救援 Succor,依從性　Adherence,捐款 Donation,奉獻 Dedication,2008年共有897個針具交換點，分布在26省526個縣,為月均36,000IDUs提供清潔針具 In 2008，897 NEP operate in 526 counties (district) in 2

39、6 provinces, serving average 36,000 injecting drug users monthly.發(fā)放針具（Distributed Needles）：1,173,764 回收針具（Collected needles）: 1,060,497,針具交換項目The progress of the NEP in 2008,減低危害策略Harm Reduction Strategy,MMT:減少毒

40、品濫用和毒品相關(guān)的犯罪 Reduce drug use, drug related crime and 減少艾滋病新發(fā)感染率 Reduce transmission of HIV/AIDS改善家庭和社會功能 Improve quality of life of drug users – developing a harmonious society萎縮毒品交易市場 Shrink h

41、eroin markets減少新的毒品使用者 Reduce the number of new drug users充分利用MMT 項目 Services should be utilized as much as possible,,減低危害策略Harm Reduction Strategy,NEPs: 僅降低與靜脈注射相關(guān)的艾滋病等血源性傳播，但 對減少毒品濫用和毒品相關(guān)的社會

42、犯罪無明顯作用Only addresses injecting related AIDS epidemic,not targeted at reducing drug use or drug-related crime 城市和IDUs相對集中的地方推廣MMT Urban areas and the places where IDUs concentrated use MMT 邊遠農(nóng)村地區(qū)和吸毒人

43、員相對分散的地方推廣NEPs Remote and rural areas and the places where IDUs not concentrated use NEPs,社區(qū)藥物維持治療　面臨的挑戰(zhàn)和應(yīng)對策略Challenges and Response,目前存在的問題和挑戰(zhàn)Challenges Ahead,部分地區(qū)領(lǐng)導(dǎo)認識和重視不足 Lack of adequate political c

44、ommitment at local level.多部門合作尚未形成有效的合力 Need to further enhance multi-sectoral cooperation at the local level.,,目前存在的問題和挑戰(zhàn)Challenges Ahead (con’t),維持治療覆蓋面有待進一步擴大和合理化 Need to further rationally expand coverage

45、of the MMT program 部分門診在治人數(shù)和保持率偏低，脫失率較高 Need to increase the retention rate and reduce patient drop-out 美沙酮門診應(yīng)成為禁吸防艾和社會支持的綜合服務(wù)平臺 Need to make MMT clinics serve as platform for comprehensive interven

46、tion and social support.,,目前存在的問題和挑戰(zhàn)Challenges Ahead (con’t),門診工作人員能力有待加強 Need to strengthen capacity building for clinical staff 各地區(qū)門診后期綜合干預(yù)工作開展不平衡 Reduce the inequality in the spread of comprehensiv

47、e interventions and support provided to clinics 美沙酮維持劑量偏低 Improve the dosing of Methadone,,目前存在的問題和挑戰(zhàn)Challenges Ahead (con’t),社區(qū)美沙酮維持治療與針具交換項目的未能有機地結(jié)合 Appropriate combination of NEPs and MMT program needs to

48、be strengthened病人仍存在畏懼心理，交通不便、繳費困難和流動性大等現(xiàn)況 Fear of being arrested and the problems of transportation and fee-payment.,,深化部門合作Deepen and optimize the multi sectors cooperation,配合國家新出臺的禁毒法和戒毒條例（即將出臺），以及“在控率”的工作要求，加強

49、并優(yōu)化部門合作。 The enforcement of the new National Drug Control Law and the related regulations保障藥品供應(yīng)和安全 Guarantee methadone supply and safe management,,提高門診管理和服務(wù)質(zhì)量Improve access to, and the quality of MMT services,

50、提高入組人數(shù) Increase enrollment in the MMT program充分發(fā)揮同伴教育者的作用 Fully mobilize peer education加強部門配合，做好出所和入組的“無縫連接”。 Build connections between incarceration centers and MMT clinics to enable drug users to access MMT

51、 upon their release.開展社區(qū)和家庭幫教工作 Advocate the involvement of family members and the community to provide social support 針具交換點病人的轉(zhuǎn)介工作 Enhance the referral system between the NEP and MMT programs.,,提高門診管理和服務(wù)質(zhì)量I

52、mprove access to, and the quality of MMT services,提高保持率 Improve adherence and the retention rate 推廣后期綜合干預(yù)工作 Enhance the practice of comprehensive intervention and care 提高美沙酮治療劑量 Improve the ove

53、rall dosage of methadone use 提高門診人員的能力和衛(wèi)生服務(wù)質(zhì)量。 Improve the capacity and quality of health delivery 開展門診激勵機制 Provide incentives for adherence推廣IC卡，規(guī)范并簡化診療工作，提高依從性和保持率。 Apply Intelligence-Card Managem

54、ent System to further standardize the program,,加強人員能力建設(shè)Strengthen the capacity building,加強省級工作組的能力：督導(dǎo)計劃和技術(shù)支持能力 Strengthen the capacity of planning and M&E of Provincial Working Group/Secretariat完善培訓(xùn)方案

55、: 后期綜合干預(yù)培訓(xùn)方式（現(xiàn)場） Focus more training emphasis on comprehensive intervention and social support.,,國家級工作組督導(dǎo) M&E by National Working Group 國家級工作組/秘書處督導(dǎo)計劃/省級交叉督導(dǎo) M&E by National Working Grou

56、p/Secretariat 省級工作組督導(dǎo)和自查 M&E by Provincial Working Group/Secretariat,加強維持治療督導(dǎo)力度和效果Reinforce monitoring and evaluation,,加強數(shù)據(jù)管理質(zhì)量Enhance database management,提高數(shù)據(jù)整合和分析能力 Improve database management to

57、guide daily operation 利用數(shù)據(jù)結(jié)果提供決策依據(jù) To provide evidence-based experience to inform further policy development,,,,2009年工作重點The focus of 2009,門診建設(shè)突破700個 Scaling-up to 700 MMT clinics進一步拓展覆蓋面，使布局更為合理 Incre