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BACKGROUND: Delivering methadone treatment in community health facilities by primary care providers is a task-shifting strategy to expand access to drug use treatment, especially in rural mountainous areas. This study aims to investigate factors related to confidence in providing methadone treatment among primary care providers in Vietnam to inform good practice development. METHODS: We conducted a cross-sectional survey with 276 primary care providers who were physicians, physician assistants, nurses, pharmacists or dispensing staff from 67 communes in a mountainous province in Northern Vietnam. Using self-report scales, we measured providers confidence in providing methadone treatment, beliefs in harm reduction, perceived work-related support, perceived stigma and risk in working with drug-using patients, and empathy towards this population. We used multiple linear regression analyses to explore factors associated with providers confidence in providing methadone treatment in the whole sample and to compare two groups of providers who did and did not have experience providing methadone. Potential associated factors were measured at facility and provider levels. RESULT: 114 (41.3%) participants had previously experience in providing methadone treatment. Providers with methadone treatment experiences had higher confidence in and more accurate knowledge of methadone treatment, perceived less stigma of working with drug-using patients, and reported more work-related support than those without experiences. Higher medical education is associated with lower confidence in providing methadone treatment among providers without methadone experiences, but higher confidence among providers with methadone experiences. Better methadone knowledge was associated with greater confidence in providing methadone treatment among inexperienced providers but not among those with experiences. Receiving work-related support was associated with greater confidence in providing treatment in bo

BackgroundStarting in 2008, Vietnam's national MMT program expanded quickly, but it is struggling with increasing attrition rates and poor adherence among patients. Several studies have reported on MMT retention and adherence, but no overview has yet been published. The objective of this study is to fill that gap and to review factors associated with retention and adherence in MMT in Vietnam.MethodsA systematic search was conducted using databases of literature - Pubmed, Cochrane, Scopus, Academic search premiere, and SoINDEX. Peer-reviewed empirical studies with full text in English discussing retention attrition and adherence regarding MMT in Vietnam were selected. The results were synthesized using qualitative methods.ResultsAdherence and retention rates varied among the 11 included studies. In general, patients in mountainous provinces had lower adherence and retention rates than those in big cities. Retention rates decreased with the studies' follow-up period and had a downward trend over time. Factors associated with adherence and retention can be classified into three groups: individual, community, and institutional factors. Important individual factors areage, education, awareness of MMT and HIV, and co-occurring disorders and comorbidities. Stigma is the major community risk factor, and methadone daily dose, the distance between home and clinic, and clinic's service hours are the three most important institutional factors.ConclusionsThe literature reviewed identifies important factors associated with MMT adherence and retention in Vietnam. The findings suggest further research exploring both subjective and objective factors and more policies to remove social and structural barriers to enhance treatment outcomes.

ObjectivesTo assess the severity of methamphetamine use among methadone maintenance treatment (MMT) patients in Vietnam with opioid use disorder and concurrent methamphetamine use, and to identify risk factors associated with higher severity of methamphetamine use.MethodsWe used survey data and medical record abstractions from 428 people with opioid use disorder who also use methamphetamine while partaking in methadone treatment in five clinics in Hanoi, Vietnam. We used multinomial logistic regression to assess other risk factors and problems associated with high methamphetamine use severity.ResultsThose who reported injecting heroin in the past 3 months (AOR = 4.05, 95% CI [1.30, 12.55], p = 0.02), having a longer history of lifetime heroin use (AOR = 1.13, 95% CI [1.03, 1.24], p < 0.01), and having higher cravings (AOR = 1.97, 95% CI [1.31, 2.98], p < 0.01) and fatigue (AOR = 1.25, 95% CI [0.96, 1.61], p = 0.09) related to methamphetamine withdrawal had greater odds of high methamphetamine use severity. One of five clinics had a significantly higher percentage of methamphetamine use severity than others.ConclusionSuccessful MMT in patients with opioid use disorder in Vietnam may additionally require methamphetamine-focused screening and intervention.

ObjectiveService providers' job satisfaction is critical to the stability of the work force and thereby the effectiveness of methadone maintenance treatment (MMT) programs. This study aimed to explore MMT clinic service providers' job satisfaction and associated factors in Jiangsu, China.MethodsThis secondary study used baseline data of a randomized interventional trial implemented in Jiangsu, China. A survey was conducted among 76 MMT service providers using the computer-assisted self-interview (CASI) method. Job satisfaction responses were assessed via a 30-item scale, with a higher score indicating a higher level of job satisfaction. Perceived institutional support and perceived stigma due to working with drug users were measured using a 9-item scale. Correlation and multiple linear regression analyses were performed to identify factors associated with job satisfaction.ResultsCorrelation analyses found a significant association between job satisfaction and having professional experience in the prevention and control of HIV, other sexually transmitted infections, or other infectious diseases (P = 0.046). Multiple regression analyses revealed that working at MMT clinics affiliated with Center for Disease Control and Prevention sites was associated with a lower level of job satisfaction (P = 0.014), and perception of greater institutional support (P = 0.001) was associated with a higher level of job satisfaction.ConclusionJob satisfaction among MMT clinic service providers was moderate in our study. Our findings suggest that institutional support for providers should be improved, and that acquisition of additional expertise should be encouraged.

ObjectiveService providers' job satisfaction is critical to the stability of the work force and thereby the effectiveness of methadone maintenance treatment (MMT) programs. This study aimed to explore MMT clinic service providers' job satisfaction and associated factors in Jiangsu, China.MethodsThis secondary study used baseline data of a randomized interventional trial implemented in Jiangsu, China. A survey was conducted among 76 MMT service providers using the computer-assisted self-interview (CASI) method. Job satisfaction responses were assessed via a 30-item scale, with a higher score indicating a higher level of job satisfaction. Perceived institutional support and perceived stigma due to working with drug users were measured using a 9-item scale. Correlation and multiple linear regression analyses were performed to identify factors associated with job satisfaction.ResultsCorrelation analyses found a significant association between job satisfaction and having professional experience in the prevention and control of HIV, other sexually transmitted infections, or other infectious diseases (P = 0.046). Multiple regression analyses revealed that working at MMT clinics affiliated with Center for Disease Control and Prevention sites was associated with a lower level of job satisfaction (P = 0.014), and perception of greater institutional support (P = 0.001) was associated with a higher level of job satisfaction.ConclusionJob satisfaction among MMT clinic service providers was moderate in our study. Our findings suggest that institutional support for providers should be improved, and that acquisition of additional expertise should be encouraged.

BackgroundDrug use stigma among service providers has been recognized as a barrier to improving the accessibility and outcomes of addiction treatment. This study examined the stigmatizing attitudes towards people who use drugs (PWUD) among service providers in methadone maintenance treatment (MMT) clinics in China and its associated factors.MethodsThe cross-sectional study used the baseline data of a randomized intervention trial conducted in China, and the data were collected from January 2012 to August 2013. A total of 418 MMT service providers were included in the study. Stigma towards PWUD was measured via a 10-item scale embedded in two case vignettes (PWUD and non-PWUD). The Wilcoxon signed-rank test was performed to evaluate the vignette difference for each item of the scale. The linear mixed model was used to identify the adjusted association between drug use stigma and other interested variables including demographics, professional background, and MMT knowledge of the service providers.ResultsThe Wilcoxon signed-rank tests showed that the participants had a higher level of stigmatizing attitudes towards PWUD than non-PWUD (p-value<0.001 for all items of the stigma scale). The linear mixed model identified that the reception of national MMT training was associated with a lower degree of drug use stigma (estimate=-1.79; 95% CI: -3.13, -0.45; p-value = 0.009).ConclusionThe findings of the study provide evidence of the existence of drug use stigma among MMT providers in China. The expansion of national-level training and the development of stigma reduction interventions are needed to address this issue.

BackgroundService providers including doctors, nurses, and other healthcare professionals play an essential role in methadone maintenance treatment (MMT). This study evaluated the impact of an intervention targeting MMT providers on their clients' treatment retention.MethodsThis study was conducted in 68 MMT clinics in five provinces of China with 36 clients randomly selected from each clinic. The clinics were randomized to intervention or control condition. The MMT CARE intervention started with group sessions to enhance providers' communication skills. The trained providers were encouraged to conduct individual sessions with clients to promote treatment engagement. The outcomes, which include client retention (main outcome) and their reception of provider-delivered individual sessions (process outcome), were measured over a 24-month period.ResultsSignificantly fewer intervention clients dropped out from MMT than control clients during the study period (31% vs. 41%; p < 0.0001). Dropout hazard was significantly lower in the intervention condition compared to the control condition (HR = 0.71, 95% CI: 0.57, 0.89). More intervention clients had individual sessions than control clients (93% vs. 70%; p < 0.0001). Having individual sessions was associated with a significantly lower dropout hazard (HR = 0.30, 95% CI: 0.23, 0.40). The intervention clients had a significantly lower dropout hazard than the control clients if they started the individual sessions during the first six months (HR = 0.68, 95% CI: 0.51, 0.90).ConclusionsThe MMT CARE intervention focusing on provider capacity building has demonstrated efficacy in reducing clients' treatment dropout. This study sheds light on MMT service improvement in China and other global community-based harm reduction programs.

BackgroundService providers including doctors, nurses, and other healthcare professionals play an essential role in methadone maintenance treatment (MMT). This study evaluated the impact of an intervention targeting MMT providers on their clients' treatment retention.MethodsThis study was conducted in 68 MMT clinics in five provinces of China with 36 clients randomly selected from each clinic. The clinics were randomized to intervention or control condition. The MMT CARE intervention started with group sessions to enhance providers' communication skills. The trained providers were encouraged to conduct individual sessions with clients to promote treatment engagement. The outcomes, which include client retention (main outcome) and their reception of provider-delivered individual sessions (process outcome), were measured over a 24-month period.ResultsSignificantly fewer intervention clients dropped out from MMT than control clients during the study period (31% vs. 41%; p < 0.0001). Dropout hazard was significantly lower in the intervention condition compared to the control condition (HR = 0.71, 95% CI: 0.57, 0.89). More intervention clients had individual sessions than control clients (93% vs. 70%; p < 0.0001). Having individual sessions was associated with a significantly lower dropout hazard (HR = 0.30, 95% CI: 0.23, 0.40). The intervention clients had a significantly lower dropout hazard than the control clients if they started the individual sessions during the first six months (HR = 0.68, 95% CI: 0.51, 0.90).ConclusionsThe MMT CARE intervention focusing on provider capacity building has demonstrated efficacy in reducing clients' treatment dropout. This study sheds light on MMT service improvement in China and other global community-based harm reduction programs.

BackgroundDrug use stigma among service providers has been recognized as a barrier to improving the accessibility and outcomes of addiction treatment. This study examined the stigmatizing attitudes towards people who use drugs (PWUD) among service providers in methadone maintenance treatment (MMT) clinics in China and its associated factors.MethodsThe cross-sectional study used the baseline data of a randomized intervention trial conducted in China, and the data were collected from January 2012 to August 2013. A total of 418 MMT service providers were included in the study. Stigma towards PWUD was measured via a 10-item scale embedded in two case vignettes (PWUD and non-PWUD). The Wilcoxon signed-rank test was performed to evaluate the vignette difference for each item of the scale. The linear mixed model was used to identify the adjusted association between drug use stigma and other interested variables including demographics, professional background, and MMT knowledge of the service providers.ResultsThe Wilcoxon signed-rank tests showed that the participants had a higher level of stigmatizing attitudes towards PWUD than non-PWUD (p-value<0.001 for all items of the stigma scale). The linear mixed model identified that the reception of national MMT training was associated with a lower degree of drug use stigma (estimate=-1.79; 95% CI: -3.13, -0.45; p-value = 0.009).ConclusionThe findings of the study provide evidence of the existence of drug use stigma among MMT providers in China. The expansion of national-level training and the development of stigma reduction interventions are needed to address this issue.

BACKGROUND: Service providers including doctors, nurses, and other healthcare professionals play an essential role in methadone maintenance treatment (MMT). This study evaluated the impact of an intervention targeting MMT providers on their clients treatment retention. METHODS: This study was conducted in 68 MMT clinics in five provinces of China with 36 clients randomly selected from each clinic. The clinics were randomized to intervention or control condition. The MMT CARE intervention started with group sessions to enhance providers communication skills. The trained providers were encouraged to conduct individual sessions with clients to promote treatment engagement. The outcomes, which include client retention (main outcome) and their reception of provider-delivered individual sessions (process outcome), were measured over a 24-month period. RESULTS: Significantly fewer intervention clients dropped out from MMT than control clients during the study period (31% vs. 41%; p < 0.0001). Dropout hazard was significantly lower in the intervention condition compared to the control condition (HR = 0.71, 95% CI: 0.57, 0.89). More intervention clients had individual sessions than control clients (93% vs. 70%; p < 0.0001). Having individual sessions was associated with a significantly lower dropout hazard (HR = 0.30, 95% CI: 0.23, 0.40). The intervention clients had a significantly lower dropout hazard than the control clients if they started the individual sessions during the first six months (HR = 0.68, 95% CI: 0.51, 0.90). CONCLUSIONS: The MMT CARE intervention focusing on provider capacity building has demonstrated efficacy in reducing clients treatment dropout. This study sheds light on MMT service improvement in China and other global community-based harm reduction programs.

BACKGROUND: Drug use stigma among service providers has been recognized as a barrier to improving the accessibility and outcomes of addiction treatment. This study examined the stigmatizing attitudes towards people who use drugs (PWUD) among service providers in methadone maintenance treatment (MMT) clinics in China and its associated factors. METHODS: The cross-sectional study used the baseline data of a randomized intervention trial conducted in China, and the data were collected from January 2012 to August 2013. A total of 418 MMT service providers were included in the study. Stigma towards PWUD was measured via a 10-item scale embedded in two case vignettes (PWUD and non-PWUD). The Wilcoxon signed-rank test was performed to evaluate the vignette difference for each item of the scale. The linear mixed model was used to identify the adjusted association between drug use stigma and other interested variables including demographics, professional background, and MMT knowledge of the service providers. RESULTS: The Wilcoxon signed-rank tests showed that the participants had a higher level of stigmatizing attitudes towards PWUD than non-PWUD (p-value<0.001 for all items of the stigma scale). The linear mixed model identified that the reception of national MMT training was associated with a lower degree of drug use stigma (estimate=-1.79; 95% CI: -3.13, -0.45; p-value = 0.009). CONCLUSION: The findings of the study provide evidence of the existence of drug use stigma among MMT providers in China. The expansion of national-level training and the development of stigma reduction interventions are needed to address this issue.

BackgroundThe use of heroin during Methadone Maintenance Treatment (MMT) is a challenging problem that contributes to poor treatment outcomes. Families may play an important role in addressing concurrent heroin use during MMT, especially in collectivist societies such as China.ObjectivesIn this study, we explored the relationship between family-related factors and concurrent heroin use during MMT in China.MethodsThis study was conducted at 68 MMT clinics in five provinces of China. There were 2,446 MMT clients in the analysis. Demographic information, MMT dosage, family members' heroin use status, family support of MMT, family problem, and self-reported heroin use were collected in a cross-sectional survey. The most recent urinalysis of opiate use was obtained from clinical records.ResultsOf the 2,446 participants, 533 (21.79%) self-reported heroin use in the previous seven days or had a positive urine morphine test result in the clinic record. Participants whose family member[s] used heroin were 1.59 times (95% CI: 1.17, 2.15) more likely to use concurrently during treatment. Those with family members who totally support them on the MMT were less likely to use (AOR: 0.75, 95% CI: 0.60, 0.94). Having more family problems was positively associated with concurrent heroin use (AOR: 2.01, 95% CI: 1.03, 3.93).ConclusionsThe results highlight the importance of the family's role in concurrent heroin use during MMT programs. The study's findings may have implications for family-based interventions that address concurrent heroin use.

BackgroundThe use of heroin during Methadone Maintenance Treatment (MMT) is a challenging problem that contributes to poor treatment outcomes. Families may play an important role in addressing concurrent heroin use during MMT, especially in collectivist societies such as China.ObjectivesIn this study, we explored the relationship between family-related factors and concurrent heroin use during MMT in China.MethodsThis study was conducted at 68 MMT clinics in five provinces of China. There were 2,446 MMT clients in the analysis. Demographic information, MMT dosage, family members' heroin use status, family support of MMT, family problem, and self-reported heroin use were collected in a cross-sectional survey. The most recent urinalysis of opiate use was obtained from clinical records.ResultsOf the 2,446 participants, 533 (21.79%) self-reported heroin use in the previous seven days or had a positive urine morphine test result in the clinic record. Participants whose family member[s] used heroin were 1.59 times (95% CI: 1.17, 2.15) more likely to use concurrently during treatment. Those with family members who totally support them on the MMT were less likely to use (AOR: 0.75, 95% CI: 0.60, 0.94). Having more family problems was positively associated with concurrent heroin use (AOR: 2.01, 95% CI: 1.03, 3.93).ConclusionsThe results highlight the importance of the family's role in concurrent heroin use during MMT programs. The study's findings may have implications for family-based interventions that address concurrent heroin use.

BackgroundThe use of heroin during Methadone Maintenance Treatment (MMT) is a challenging problem that contributes to poor treatment outcomes. Families may play an important role in addressing concurrent heroin use during MMT, especially in collectivist societies such as China.ObjectivesIn this study, we explored the relationship between family-related factors and concurrent heroin use during MMT in China.MethodsThis study was conducted at 68 MMT clinics in five provinces of China. There were 2,446 MMT clients in the analysis. Demographic information, MMT dosage, family members' heroin use status, family support of MMT, family problem, and self-reported heroin use were collected in a cross-sectional survey. The most recent urinalysis of opiate use was obtained from clinical records.ResultsOf the 2,446 participants, 533 (21.79%) self-reported heroin use in the previous seven days or had a positive urine morphine test result in the clinic record. Participants whose family member[s] used heroin were 1.59 times (95% CI: 1.17, 2.15) more likely to use concurrently during treatment. Those with family members who totally support them on the MMT were less likely to use (AOR: 0.75, 95% CI: 0.60, 0.94). Having more family problems was positively associated with concurrent heroin use (AOR: 2.01, 95% CI: 1.03, 3.93).ConclusionsThe results highlight the importance of the family's role in concurrent heroin use during MMT programs. The study's findings may have implications for family-based interventions that address concurrent heroin use.

Due to their geographical characteristics, the mountainous areas of Vietnam are particularly vulnerable to illicit drug use. Drug users in remote areas are also more likely to engage in risky sexual behaviors. This study aimed to describe the prevalence and characteristics of substance use and sexual behaviors and explored their related factors among newly admitted drug users in three mountainous provinces of Vietnam. A cross-sectional study was conducted on 300 newly-admitted drug users registering for Methadone Maintenance Treatment (MMT) at 6 clinics in three provinces: Dien Bien, Lai Chau and Yen Bai from October 2014 to December 2015. Information about the socio-demographic characteristics, history of substance use, and sexual behaviors were collected. The multivariate logistic regression model was used to identify potential predictors of four outcomes, which included: drug injection, re-use of needles, using condoms during the last time of having sex, and having sexual intercourse with female sex workers. The proportion of injecting drug users was 68.3%; of those 9% never re-used needles. Of note, 69% of those who reported having sex with female sex workers in the last month did not use condoms. Regression models showed that those who injected drugs and had health problems in last 30 days had greater odds of having sex with female sex workers. Drug users in mountainous settings acknowledged the high prevalence of human immunodeficiency virus (HIV)-related risk behaviors and a demand for physical and psychological care. Scaling up MMT services is key to approaching this high-risk group; however, at the same time, comprehensive harm-reduction interventions, counseling, and health care services should also be made accessible and effective in this setting., SCOPUS: ar.j, info:eu-repo/semantics/published

BackgroundThis study examined clients' treatment satisfaction with the services provided by methadone maintenance treatment (MMT) in China and explored relevant factors that are directly or indirectly associated with treatment satisfaction.MethodsThe study used baseline data from a randomized controlled trial conducted among 2,448 clients from 68 MMT clinics in five provinces of China. The participants reported their demographic characteristics, treatment-related factors, depressive symptoms, treatment progression, counseling rapport, and treatment satisfaction. Structural equation modeling (SEM) was used to test the direct and indirect relationships among various factors and treatment satisfaction.ResultsClients' demographic characteristics, such as older age, had both a direct effect on treatment satisfaction and an indirect effect mediated by counseling rapport. Depressive symptoms and a lack of social support had a direct negative impact on treatment satisfaction and an indirect effect mediated by treatment progression and counseling rapport. Both mediators: treatment progression (estimate=0.227, p<0.01) and counseling rapport (estimate=0.229, p<0.01), showed positive associations with treatment satisfaction.ConclusionThe findings reiterate the complex nature of MMT clients' treatment satisfaction and its interrelationship with multidimensional factors. The study has implications for evaluating the quality of care provided by MMT programs and suggests several strategies that can potentially improve MMT clients' level of treatment satisfaction.

__Background:__ Since 2003, a harm reduction program for injecting drug users has been rolled out countrywide in China. It entails services for condom promotion, a needle and syringe program (NSP), and methadone maintenance treatment (MMT). However, it remains unknown if and to what extent the coverage of these services at city level is related to a reduced risk of HIV infection among drug users. __Methods:__ We wished to quantify the extent to which city-level characteristics (such as NSP and MMT service coverage) and individual-level determinants (e.g., self-reported exposure to NSP and MMT services, knowledge, motivation, and skills) were associated with the risk of HIV infection among drug users. In 2006, we conducted an integrated serological and behavioral survey among drug users in five cities of Yunnan Province, China (N = 685), constructing a multilevel logistic regression model with drug users clustered within these cities. __Results:__ Drug users who reported having received NSP or MMT services were about 50% less likely to be infected with HIV than those who reported not having received them (OR 0.45, 95% CI, 0.26-0.83 for NSP and 0.48, 95% CI, 0.31-0.73 for MMT). Despite a between-city variation of HIV infection risk (ICC 0.24, 95% CI 0.08-0.54), none of the city-level factors could explain this difference. Individual-level determinants such as perceived risk of infection and use of condoms were not associated with HIV infection. __Conclusions:__ Although people who had used NSP or MMT services were less likely to be HIV infected, this study found no relationship between city-level coverage of HIV prevention programs and variations in HIV infection between cities. This may have been due to the low number of cities in the analysis. Future research should include the analysis of data from a larger number of cities, which are collected widely in China through integrated behavioral and serological surveys.

BackgroundThis study examined clients' treatment satisfaction with the services provided by methadone maintenance treatment (MMT) in China and explored relevant factors that are directly or indirectly associated with treatment satisfaction.MethodsThe study used baseline data from a randomized controlled trial conducted among 2,448 clients from 68 MMT clinics in five provinces of China. The participants reported their demographic characteristics, treatment-related factors, depressive symptoms, treatment progression, counseling rapport, and treatment satisfaction. Structural equation modeling (SEM) was used to test the direct and indirect relationships among various factors and treatment satisfaction.ResultsClients' demographic characteristics, such as older age, had both a direct effect on treatment satisfaction and an indirect effect mediated by counseling rapport. Depressive symptoms and a lack of social support had a direct negative impact on treatment satisfaction and an indirect effect mediated by treatment progression and counseling rapport. Both mediators: treatment progression (estimate=0.227, p<0.01) and counseling rapport (estimate=0.229, p<0.01), showed positive associations with treatment satisfaction.ConclusionThe findings reiterate the complex nature of MMT clients' treatment satisfaction and its interrelationship with multidimensional factors. The study has implications for evaluating the quality of care provided by MMT programs and suggests several strategies that can potentially improve MMT clients' level of treatment satisfaction.

Background: China introduced the Methadone Maintenance Treatment (MMT) to cope with the rapidly rising number of heroin users and related increases in the prevalence of HIV for a decade. Currently, China’s MMT program is the largest single MMT program in the world. However, relatively low retention rate of MMT has been a concern for China’s MMT program ever since the first pilot was initiated. The objectives of the prospective cohort study are: 1) To document the retention rate of MMT program and identify the factors associated with retention of MMT in Yunnan. 2) To examined effect of MMT for 204 drug users who entered methadone maintenance between baseline and 6-month follow-up. Methods: Anonymous in-depth interviews were conducted with 13 clients of MMT clinics, 18 dropouts from MMT, 8 officers and 19 services providers of MMT program. The perceived facilitators and barrier associated with retention of MMT from the perspectives of clients and service providers were documented. Meanwhile, a prospective cohort study was employed in this study. 523 clients from the four selected MMT clinics from four city/prefectures of Yunnan Province were recruited into the cohort, beginning on January 2014 and followed up until September 2014. In total, 523 clients completed questionnaire interview at baseline and 204 clients who still remained in MMT clinics were interviewed at six-month follow up. Additionally, to evaluate the effects of MMT program, this study also compared the baseline information and followed up information among the 204 clients who were remaining in the MMT program.Results: The qualitative study revealed that over ten years, MMT program has already gradually accepted by societies including the department of public security. Fear of arresting in and/or around MMT clinics was not a major barrier for accessing and remaining in. Service providers believed they are able to prescribe appropriate dosage of methadone to clients. However, that methadone dose and dose

Background: China introduced the Methadone Maintenance Treatment (MMT) to cope with the rapidly rising number of heroin users and related increases in the prevalence of HIV for a decade. Currently, China’s MMT program is the largest single MMT program in the world. However, relatively low retention rate of MMT has been a concern for China’s MMT program ever since the first pilot was initiated. The objectives of the prospective cohort study are: 1) To document the retention rate of MMT program and identify the factors associated with retention of MMT in Yunnan. 2) To examined effect of MMT for 204 drug users who entered methadone maintenance between baseline and 6-month follow-up. Methods: Anonymous in-depth interviews were conducted with 13 clients of MMT clinics, 18 dropouts from MMT, 8 officers and 19 services providers of MMT program. The perceived facilitators and barrier associated with retention of MMT from the perspectives of clients and service providers were documented. Meanwhile, a prospective cohort study was employed in this study. 523 clients from the four selected MMT clinics from four city/prefectures of Yunnan Province were recruited into the cohort, beginning on January 2014 and followed up until September 2014. In total, 523 clients completed questionnaire interview at baseline and 204 clients who still remained in MMT clinics were interviewed at six-month follow up. Additionally, to evaluate the effects of MMT program, this study also compared the baseline information and followed up information among the 204 clients who were remaining in the MMT program.Results: The qualitative study revealed that over ten years, MMT program has already gradually accepted by societies including the department of public security. Fear of arresting in and/or around MMT clinics was not a major barrier for accessing and remaining in. Service providers believed they are able to prescribe appropriate dosage of methadone to clients. However, that methadone dose and dose

ObjectiveThe aim of this study was to evaluate the risk factors associated with dropout from Methadone Maintenance Treatment (MMT) clinics within a 1 year follow-up cohort study in China.MethodsA data analysis is to explore the adherence of MMT during one year from three hundred and twenty patients with heroin dependence at five clinics (3 in Shanghai, 2 in Kunming) in China. All participants were from the part of China-United States cooperation project entitled "Research about improving the compliance and efficacy of methadone maintenance treatment in China". Our data analysis includes the patients' attendance in the 6 months clinical study and the data in another 6 months afterward. The data of patients at baseline were collected with the Addiction Severity Index (ASI) which is a semi-structured questionnaire covering socio-demographic characteristics and drug use history. The one year attendance after recruitment at the clinics and daily dose were abstracted from the MMT clinic register system. The Cox proportional hazards model were used to explore the risk factor of dropout, defined as seven consecutive days without methadone.ResultsBy the end of 1 year of treatment 86 patients still remained in MMT without dropout (87% in Shanghai and 13% patients in Kunming). Over the entire 1-year period the median days of remaining in the program were 84 days (in Shanghai and Kunming were 317 days and 22 days).The factors associated with retention included age (HR=0.98, 95%C.I.:0.96-0.99, P=0.0062) and ASI alcohol scores (HR=5.72, 95%C.I.:1.49-21.92, P=0.0109) at baseline.ConclusionOne year retention of newly recruited patients with heroin dependence was related to age and ASI alcohol scores at baseline. The adherence is poorer for the patients who are young and having more serious alcohol problems.

BackgroundTo investigate factors associated with retention among the first cohort of drug users attending methadone maintenance treatment (MMT) clinics in China.MethodsA six-year cohort of 1511 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.ResultsThe 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.ConclusionsHealth 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.

ObjectiveThe aim of this study was to evaluate the risk factors associated with dropout from Methadone Maintenance Treatment (MMT) clinics within a 1 year follow-up cohort study in China.MethodsA data analysis is to explore the adherence of MMT during one year from three hundred and twenty patients with heroin dependence at five clinics (3 in Shanghai, 2 in Kunming) in China. All participants were from the part of China-United States cooperation project entitled "Research about improving the compliance and efficacy of methadone maintenance treatment in China". Our data analysis includes the patients' attendance in the 6 months clinical study and the data in another 6 months afterward. The data of patients at baseline were collected with the Addiction Severity Index (ASI) which is a semi-structured questionnaire covering socio-demographic characteristics and drug use history. The one year attendance after recruitment at the clinics and daily dose were abstracted from the MMT clinic register system. The Cox proportional hazards model were used to explore the risk factor of dropout, defined as seven consecutive days without methadone.ResultsBy the end of 1 year of treatment 86 patients still remained in MMT without dropout (87% in Shanghai and 13% patients in Kunming). Over the entire 1-year period the median days of remaining in the program were 84 days (in Shanghai and Kunming were 317 days and 22 days).The factors associated with retention included age (HR=0.98, 95%C.I.:0.96-0.99, P=0.0062) and ASI alcohol scores (HR=5.72, 95%C.I.:1.49-21.92, P=0.0109) at baseline.ConclusionOne year retention of newly recruited patients with heroin dependence was related to age and ASI alcohol scores at baseline. The adherence is poorer for the patients who are young and having more serious alcohol problems.

BackgroundTo investigate factors associated with retention among the first cohort of drug users attending methadone maintenance treatment (MMT) clinics in China.MethodsA six-year cohort of 1511 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.ResultsThe 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.ConclusionsHealth 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.

This study examined nation-wide data from China to assess client outcomes after 6-months of methadone treatment. Data on 19,026 clients enrolled between April 2008 and March 2010 were reviewed for changes in HIV-risk behaviours and emergence of new HIV cases. Multivariable logistic regression was used to identify factors associated with illicit drug use while in MMT. Clients reported reduced drug use and related risk behaviours and improved social functioning. There were 24 newly-identified cases of HIV. Continued drug use was associated with low attendance (OR=5.98, 95% CI=4.69-7.63), frequently seeing drug using friends (OR=3.72 for daily vs. never, 95% CI=3.18-4.34) and having a difficult family relationship (OR=2.03 for difficult vs. good, 95% CI=1.63-2.52). Methadone dose was not associated with continued drug use while in treatment. The Chinese MMT programme appears to be having a positive influence on those clients who remain in treatment, but needs to explore strategies to increase accessibility.

Background: The Chinese Methadone Maintenance Treatment (MMT) Program was established in 2004 and has expanded rapidly to 28 provinces, autonomous regions, and municipalities with a total of 738 MMT clinics providing treatment for a cumulative total of more than 344,000 patients at the end of 2011. However, the total number of patients being treated daily accounted for less than 20% of all registered opiate users not counting the unregistered drug-using population. Coverage of the community-based MMT program is still low and the dropout rate among MMT patients remains high. The primary objective of this study is to identify barriers associated with detainees' unwillingness to participate in community-based MMT when released from compulsory drug detoxification centers in China. Methods: This study was carried out in two compulsory drug detoxification centers in Mangshi City, Dehong Prefecture, Yunnan Province. Between July and November, 2012, in-depth interviews were conducted with 20 incarcerated drug users in one center. A total of 250 incarcerated drug users was also recruited to participate in a face-to-face cross-sectional survey using a convenient sampling method in the other center.Results: The majority of our study participants expressed their unwillingness to initiate MMT enrollment post-release, which is of great concern. Most participants' reasons for unwillingness to take part were: no perceived needs to participate in MMT; misconceptions and lack of MMT-related knowledge; limited accessibility and financial difficulties. Moreover, side-effects, inconvenience, dosage and concurrent opiate and stimulant uses were indicated as reasons for dropping out. We also documented that ethnic disparities existed in this culturally and geographically diverse population. Lastly, a surprisingly high proportion of our study participants reported using stimulants, specifically ephedrine, as their primary drug of choice.Conclusions: There is an urgent need to revamp the cu

Background: The Chinese Methadone Maintenance Treatment (MMT) Program was established in 2004 and has expanded rapidly to 28 provinces, autonomous regions, and municipalities with a total of 738 MMT clinics providing treatment for a cumulative total of more than 344,000 patients at the end of 2011. However, the total number of patients being treated daily accounted for less than 20% of all registered opiate users not counting the unregistered drug-using population. Coverage of the community-based MMT program is still low and the dropout rate among MMT patients remains high. The primary objective of this study is to identify barriers associated with detainees' unwillingness to participate in community-based MMT when released from compulsory drug detoxification centers in China. Methods: This study was carried out in two compulsory drug detoxification centers in Mangshi City, Dehong Prefecture, Yunnan Province. Between July and November, 2012, in-depth interviews were conducted with 20 incarcerated drug users in one center. A total of 250 incarcerated drug users was also recruited to participate in a face-to-face cross-sectional survey using a convenient sampling method in the other center.Results: The majority of our study participants expressed their unwillingness to initiate MMT enrollment post-release, which is of great concern. Most participants' reasons for unwillingness to take part were: no perceived needs to participate in MMT; misconceptions and lack of MMT-related knowledge; limited accessibility and financial difficulties. Moreover, side-effects, inconvenience, dosage and concurrent opiate and stimulant uses were indicated as reasons for dropping out. We also documented that ethnic disparities existed in this culturally and geographically diverse population. Lastly, a surprisingly high proportion of our study participants reported using stimulants, specifically ephedrine, as their primary drug of choice.Conclusions: There is an urgent need to revamp the cu

Introduction and Aims: Australian pharmacotherapy maintenance programs incur costs to patients. These dispensing fees represent a financial burden to patients and are inconsistent with Australian health-care principles. No previous work has examined the current costs nor the future predicted costs if government subsidised dispensing fees.Design and Methods: A system dynamics model, which simulated the flow of patients into and out of methadone maintenance treatment, was developed. Costs were imputed from existing research data. The approach enabled simulation of possible behavioural responses to a fee subsidy (such as higher retention) and new estimates of costs were derived under such scenarios.Results: Current modelled costs (AUS$11.73m per month) were largely borne by state/territory government (43%), with patients bearing one-third (33%) of the total costs and the Commonwealth one-quarter (24%). Assuming no behavioural changes associated with fee subsidies, the cost of subsidising the dispensing fees of Australian methadone patients would be $3.9m per month. If retention were improved as a result of fee subsidy, treatment numbers would increase and the model estimates an additional cost of $0.8m per month. If this was coupled with greater numbers entering treatment, the costs would increase by a further $0.4m per month. In total, full fee subsidy with modelled behavioural changes would increase per annum government expenditure by $81.8m to $175.8m.Discussion and Conclusions: If government provided dispensing fee relief for methadone maintenance patients, it would be a costly exercise. However, these additional costs are offset by the social and health gains achieved from the methadone maintenance program.

Background/aims: The present study investigated the first 38 methadone maintenance treatment (MMT) patients in Stockholm. The aim was: (i) to investigate the possible predictive factors for successful treatment termination, and (ii) the long-term outcome effects and life situation of MMT patients and those who terminated the treatment. Methods: The patients were interviewed at the start and approximately 15 years later, and divided into four groups: (1) no withdrawal attempts, (2) forced to stop the treatment, (3) successful tapering and (4) non-successful tapering. Results: The predictive factor found that Group 1 showed a lower life quality compared with Groups 3 and 4. Fifteen years later, the life situations of Groups 3 and 4 were significantly more stable. Also the subjective well-being in Group 3 was significantly higher. Over all, Group 2 showed significantly more illicit drug use compared with Group 3. The social life situation was significantly improved for all patients during the 15 years. Conclusion: This study confirms our earlier findings that the ultimate goal of MMT for the motivated patients with good progress should be an opiate-free life. The life situation and subjective well-being seems to be higher after successful termination of MMT.

This research assessed the cognitive functioning of several different drug and alcohol samples, with a specific focus on individuals in methadone maintenance treatment. Additionally, this research assessed the relation between cognitive functioning and adherence to treatment in these populations. This is a link that has been suggested by research in this area previously. The present research consisted of five experiments. Experiment 1 assessed the application, within New Zealand, of the normative data for a number of psychometric tests with a non- substance using sample of New Zealand university students. The results from this study showed that the scores for the university sample were generally similar to the normative means, suggesting that the existing normative data could be used in New Zealand. Experiment 2 assessed the cognitive functioning of university students who reported regular use of alcohol and/or cannabis. The results from this study showed that the frequency of alcohol use was positively correlated with problem solving ability, while frequency of cannabis use was positively correlated with memory functioning. Cannabis use was also associated with poorer problem solving ability. These findings showed that casual use of alcohol and/or cannabis was associated with poorer functioning on some psychometric tests, and that these tests were sensitive to the effects of substance use. Experiment 3 assessed the cognitive functioning of a sample of individuals in methadone maintenance treatment in relation to their adherence to treatment. The results from this study showed deficits in memory, divided attention and cognitive flexibility, and poor mathematical ability when compared to the normative data. Treatment adherence was found to be associated with lower levels of treatment satisfaction, and findings also suggested a possible relation between poor treatment adherence and better scores on the psychometric test scores. Due to difficulties in recruiting partic

This research assessed the cognitive functioning of several different drug and alcohol samples, with a specific focus on individuals in methadone maintenance treatment. Additionally, this research assessed the relation between cognitive functioning and adherence to treatment in these populations. This is a link that has been suggested by research in this area previously. The present research consisted of five experiments. Experiment 1 assessed the application, within New Zealand, of the normative data for a number of psychometric tests with a non- substance using sample of New Zealand university students. The results from this study showed that the scores for the university sample were generally similar to the normative means, suggesting that the existing normative data could be used in New Zealand. Experiment 2 assessed the cognitive functioning of university students who reported regular use of alcohol and/or cannabis. The results from this study showed that the frequency of alcohol use was positively correlated with problem solving ability, while frequency of cannabis use was positively correlated with memory functioning. Cannabis use was also associated with poorer problem solving ability. These findings showed that casual use of alcohol and/or cannabis was associated with poorer functioning on some psychometric tests, and that these tests were sensitive to the effects of substance use. Experiment 3 assessed the cognitive functioning of a sample of individuals in methadone maintenance treatment in relation to their adherence to treatment. The results from this study showed deficits in memory, divided attention and cognitive flexibility, and poor mathematical ability when compared to the normative data. Treatment adherence was found to be associated with lower levels of treatment satisfaction, and findings also suggested a possible relation between poor treatment adherence and better scores on the psychometric test scores. Due to difficulties in recruiting partic

The project on which this report is based investigated the role takeaways play in MMT in New South Wales and Victoria, and looked closely at the conditions under which methadone is diverted to street sale and to other forms of sharing and circulation. In the process, it also identified a range of other issues of significance to MMT clients, service providers and policy makers in Australia today.

Methadone Maintenance treatment of compulsive opioid addiction was started by the study of Dole and Nyswander (1965) and has subsequently been replicated in programs throughout the world. Methadone treatment has become the most effective modality for the treatment of chronic heroin addiction. In 1966 a Swedish National methadone maintenance program was opened at the Psychiatric Research Center, Ulleråker hospital at Uppsala. The aim of this thesis was to study the outcome of methadone treatment along various lines: • An open randomised controlled study comparing the efficacy of methadone treatment and drug free treatment in 34 heroin addicts, 20-24 years of age. • Before/after comparisons of rehabilitation among 345 heroin addicts admitted during the 23 years when this was a centralised National program. • Retention in treatment. Study subjects, methods and treatment goals: Subjects underwent an admission procedure when background data was collected through hospital records, and personal interviews. Therapeutic efforts focused on vocational rehabilitation, i.e. a return to full-time work or studies, hoping to make patients abandon their drug addict’s life-style and make them socially accepted and self-supporting. Results: Thirty-four heroin addicts with a history of 4-8 years of heroin use were randomly assigned either to methadone treatment (17) or an untreated control group (17). The controls could not apply for methadone treatment until two years later. Outcome after six years observation showed that 81% became free of drug abuse, while the corresponding figure for the controls was only 1/17 (6%). The mean yearly death rate for the controls was 7.2%. Likewise, among the total material of 345 heroin addicts, 70-80% of the patients became engaged in work or studies, a significant increase compared with the situation before treatment (1.7%). The program was an effective reducer of illicit heroin use and criminality among its patients and prevented the

Methadone Maintenance treatment of compulsive opioid addiction was started by the study of Dole and Nyswander (1965) and has subsequently been replicated in programs throughout the world. Methadone treatment has become the most effective modality for the treatment of chronic heroin addiction. In 1966 a Swedish National methadone maintenance program was opened at the Psychiatric Research Center, Ulleråker hospital at Uppsala. The aim of this thesis was to study the outcome of methadone treatment along various lines: • An open randomised controlled study comparing the efficacy of methadone treatment and drug free treatment in 34 heroin addicts, 20-24 years of age. • Before/after comparisons of rehabilitation among 345 heroin addicts admitted during the 23 years when this was a centralised National program. • Retention in treatment. Study subjects, methods and treatment goals: Subjects underwent an admission procedure when background data was collected through hospital records, and personal interviews. Therapeutic efforts focused on vocational rehabilitation, i.e. a return to full-time work or studies, hoping to make patients abandon their drug addict’s life-style and make them socially accepted and self-supporting. Results: Thirty-four heroin addicts with a history of 4-8 years of heroin use were randomly assigned either to methadone treatment (17) or an untreated control group (17). The controls could not apply for methadone treatment until two years later. Outcome after six years observation showed that 81% became free of drug abuse, while the corresponding figure for the controls was only 1/17 (6%). The mean yearly death rate for the controls was 7.2%. Likewise, among the total material of 345 heroin addicts, 70-80% of the patients became engaged in work or studies, a significant increase compared with the situation before treatment (1.7%). The program was an effective reducer of illicit heroin use and criminality among its patients and prevented the

Methadone Maintenance treatment of compulsive opioid addiction was started by the study of Dole and Nyswander (1965) and has subsequently been replicated in programs throughout the world. Methadone treatment has become the most effective modality for the treatment of chronic heroin addiction. In 1966 a Swedish National methadone maintenance program was opened at the Psychiatric Research Center, Ulleråker hospital at Uppsala. The aim of this thesis was to study the outcome of methadone treatment along various lines: • An open randomised controlled study comparing the efficacy of methadone treatment and drug free treatment in 34 heroin addicts, 20-24 years of age. • Before/after comparisons of rehabilitation among 345 heroin addicts admitted during the 23 years when this was a centralised National program. • Retention in treatment. Study subjects, methods and treatment goals: Subjects underwent an admission procedure when background data was collected through hospital records, and personal interviews. Therapeutic efforts focused on vocational rehabilitation, i.e. a return to full-time work or studies, hoping to make patients abandon their drug addict’s life-style and make them socially accepted and self-supporting. Results: Thirty-four heroin addicts with a history of 4-8 years of heroin use were randomly assigned either to methadone treatment (17) or an untreated control group (17). The controls could not apply for methadone treatment until two years later. Outcome after six years observation showed that 81% became free of drug abuse, while the corresponding figure for the controls was only 1/17 (6%). The mean yearly death rate for the controls was 7.2%. Likewise, among the total material of 345 heroin addicts, 70-80% of the patients became engaged in work or studies, a significant increase compared with the situation before treatment (1.7%). The program was an effective reducer of illicit heroin use and criminality among its patients and prevented the

Methadone Maintenance treatment of compulsive opioid addiction was started by the study of Dole and Nyswander (1965) and has subsequently been replicated in programs throughout the world. Methadone treatment has become the most effective modality for the treatment of chronic heroin addiction. In 1966 a Swedish National methadone maintenance program was opened at the Psychiatric Research Center, Ulleråker hospital at Uppsala. The aim of this thesis was to study the outcome of methadone treatment along various lines: • An open randomised controlled study comparing the efficacy of methadone treatment and drug free treatment in 34 heroin addicts, 20-24 years of age. • Before/after comparisons of rehabilitation among 345 heroin addicts admitted during the 23 years when this was a centralised National program. • Retention in treatment. Study subjects, methods and treatment goals: Subjects underwent an admission procedure when background data was collected through hospital records, and personal interviews. Therapeutic efforts focused on vocational rehabilitation, i.e. a return to full-time work or studies, hoping to make patients abandon their drug addict’s life-style and make them socially accepted and self-supporting. Results: Thirty-four heroin addicts with a history of 4-8 years of heroin use were randomly assigned either to methadone treatment (17) or an untreated control group (17). The controls could not apply for methadone treatment until two years later. Outcome after six years observation showed that 81% became free of drug abuse, while the corresponding figure for the controls was only 1/17 (6%). The mean yearly death rate for the controls was 7.2%. Likewise, among the total material of 345 heroin addicts, 70-80% of the patients became engaged in work or studies, a significant increase compared with the situation before treatment (1.7%). The program was an effective reducer of illicit heroin use and criminality among its patients and prevented the

This thesis discusses an alternative to the conventional policy diffusion approach, i.e. the social constructivist translation perspective. Within the translation perspective, policy diffusion is defined as a process where meaning is constructed by temporally and spatially disembedding policy ideas from their previous context and using them as models for policy change in a new context. This brings attention to the importance of a deepened problematization of the policy concept, the actor-dependent character of translation, and to the fact that translation processes are always tied to a local context. Translation should be seen as open, continuous processes that never take place independently of the societal distribution of power. In the thesis a distinction is made between political and practical translation. Political translation processes takes place at field level in connection with authoritative decision-making, and are a question of how policy ideas are adapted to the given local political context. This discussion is followed by the creation of an analytical framework for the study of political translation. The framework combines concepts from Kingdon’s version of the garbage-can model with concepts from neo-institutional theories. The functioning of the political translation framework is empirically illustrated by way of two case studies. The first study traces the Swedish methadone issue, from the introduction of the methadone maintenance treatment in 1966 to the end of 1980s when this form of treatment gained wider acceptance. The second study covers the Swedish family doctor issue, from the launch of the proposal by the Swedish Liberal Party in the election campaign of 1976 to the abolition of the Family Doctor Act in 1995.