Challenges in providing services in methadone maintenance therapy clinics in China: Service providers' perceptions

School of Public Health, University of California at Los Angeles, Los Angeles, CA 90024, USA.
The International journal on drug policy (Impact Factor: 2.54). 10/2009; 21(3):173-8. DOI: 10.1016/j.drugpo.2009.09.002
Source: PubMed

ABSTRACT The Methadone Maintenance Therapy (MMT) program has been initiated in China since 2004. As of the end of November, 2008, 558 MMT clinics had been established countrywide. The objective of this study was to elucidate the difficulties and challenges as perceived by service providers working in MMT clinics.
One service provider from each of the 28 MMT study clinics in Zhejiang and Jiangxi Provinces of China participated in a face-to-face in-depth interview for about 1-2h to describe their perceptions of working in MMT clinics. Qualitative data were analysed using ATLAS.ti. The grounded theory was used to guide the data analysis.
Participants identified major problems in providing services in MMT clinics including lack of resources, professional training, and institutional support. Difficulties in pursuit of career, concern for personal safety, low income, heavy working load, and poor opinion of MMT by Chinese society often contributed to greater stress and burnout among the service providers.
The MMT programs in China desperately need additional resource allocation and institutional support for the current and perhaps future expansion of the programs. The service providers are in urgent need of professional training to improve the quality of care they can offer MMT clients.

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    ABSTRACT: Background To investigate factors associated with retention among the first cohort of drug users attending methadone maintenance treatment (MMT) clinics in China. Methods A six-year cohort of 1,511 drug users was enrolled in the first 8 MMT clinics in China in 2004 and followed between March, 2004 and December, 2010. Six-year retention rates were calculated and compared by methadone dosage, clinic location, and length of follow-up. Factors associated with retention were evaluated using Cox proportional hazard regression models. Results The overall retention rate over 6-year was 35.7%. Highest drop-out occurred within the first 12 months of treatment. The retention rates for the 6-year by low (≤30 mg/day), medium (31-60 mg/day), and high (>60 mg/day) methadone dosage groups were 20.8%, 34.8% and 53.2%, respectively (p < 0.001). The highest 6-year retention rate among eight clinics was 43.8%, while the lowest one was 17.7% (p < 0.001). The results from Cox proportional hazard models indicate that clients having >30 mg daily methadone dosage (p < 0.001), having relatives receiving MMT (p = 0.027), and having >10% urine morphine positive result (p < 0.001) were more likely to be retained in MMT over the six-year period. It has also found that drug injection (p = 0.005) and needle sharing (p < 0.0001) were significantly associated with better retention. Conclusions Health workers should adjust individuals’ methadone dosages as a method to prevent early treatment termination. Further studies are needed to explore the impact of severity of opiate addiction on long-term retention of MMT clients. Careful assessment of drug users upon MMT enrollment may be helpful for providing additional care to clients.
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    ABSTRACT: Methadone maintenance treatment (MMT) is a key risk reduction measure for controlling HIV transmission among drug users. Studies using traditional methods exist to distinguish between drop outs and nondrop outs. However, many nondrop outs use MMT discontinuously and no study has identified situation-specific factors predicting their showing or not showing up. This study used a case-crossover design comparing situation-specific factors appearing on the last episode of attendance versus those of the last episode of nonattendance. A total of 133 participants were recruited from two MMT clinics in Guangzhou, China. Participants were asked separately whether various situation-specific factors existed in the last episodes of nonattendance and attendance of MMT. Matched odds ratios (ORs) based on conditional logistic regression analysis were presented. The results showed that the participants attended the MMT clinics on average for 25 days in the last month. Situation-specific factors significantly predicting nonattendance included: (1) physical and mental health status: in illness (OR = 33.0, P < 0.001), in a bad mood (OR = 7.5, P < 0.001), and occurrence of an unhappy event (OR = 18.0, P < 0.001); (2) other engagement: work engagement (OR = 40.0, P < 0.001), trip to other places (OR = 83.0, P < 0.001), and social activities (OR = 10.0, P = 0.012); (3) interpersonal relationship: conflicts with family (OR = 19.0, P = 0.004); and (4) structural situational factors: financial difficulty (OR = 19.0, P = 0.004) and worrying about police arrest (OR = 12.0, P = 0.003). Other factors such as interaction with drug users and heroin use were marginally significant, while reduced methadone dosage was nonsignificant. Interventions to improve MMT adherence need to consider situation-specific factors. Ancillary psychosocial services should be integrated with current MMT; MMT should also provide more flexible services to the clients. Furthermore, efforts should be taken to build up interdisciplinary teams and to connect with MMT in order to provide holistic harm reduction, rehabilitation, and health care.
    AIDS Care 04/2014; DOI:10.1080/09540121.2014.906552 · 1.60 Impact Factor
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    ABSTRACT: AimsTo describe the data collected by the Chinese methadone maintenance treatment (MMT) system and the characteristics of clients entering the programme.DesignDescriptive study using routinely collected data from the MMT data management system for the period March 2004 and March 2010.SettingAll MMT clinics in China.ParticipantsClients who enrolled for services between March 2004 and March 2010.MeasurementsRoutinely collected data included: demographic information; drug use, sexual and criminal behaviours; status of infection with human immunodeficiency virus (HIV), hepatitis C virus (HCV) and syphilis; random urine-opiate test results; and the daily methadone dose received. Differences among clients by year were examined.FindingsDuring the period examined, there were 251 974 clients attending 684 clinics in 27 provinces. Overall, the mean age was 34.4 years, 83.8% were male, 70.2% were unemployed, 75% had ever injected drugs, 17% had shared needles and 7.4% were HIV-positive. The profile of clients changed over time, with fewer HIV-positive individuals, fewer injecting drug users, fewer needle-sharers, fewer females and fewer unemployed. Half the clients dropped out within 6 months. The average final dose received was 49.4 mg. The estimated probability of interrupting treatment before 6 months was 52.5%.Conclusions The profile of clients enrolling in methadone maintenance treatment in China is continually changing and appears to be associated with reduced risk of HIV. High dropout in the programme may limit its effectiveness. The availability of a centralized, real-time data system was extremely useful for monitoring the progress of the Chinese methadone maintenance treatment programme.
    Addiction 01/2015; 110(S1). DOI:10.1111/add.12781 · 4.60 Impact Factor

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