China MMT Project: Methadone Maintenance and HIV Prevention

The HIV/AIDS epidemic has now spread rapidly in China and is in a phase of exponential growth. Drug users have been the largest contributor to the HIV epidemic in China. In 2003, HIV prevalence among injection drug users (IDU) in Sichuan reached 27.8% in 1999 and 50% in 2003. Successful prevention of the HIV epidemic among drug users will be the key factor to blocking further spread of HIV in China.

Methadone maintenance therapy (MMT) has become a widely used harm reduction strategy to prevent HIV infection by effectively reducing drug use since methadone has been used as a substitution for heroin addiction since 1965. With the demonstrated efficacy of MMT in the treatment of drug addiction and the subsequent reduction in HIV risk behaviors, the MMT program has been scaled up. As of March 2007, 320 MMT clinics have been established in 22 provinces, autonomous regions and municipalities cumulatively treating 52,854 out-patients.

However, Chinese programmers, researchers and policy makers of MMT programs are facing special challenges. First, there is large variation in effectiveness of MMT programs. Second, patient drop-out rate is high across all sites. The proposed study aims to design a feasible MMT Plus intervention program to combine psychological and behavioral components with pharmaceutical MMT to result in effective outcome of increase in MMT retention and decrease in drug use. The specific aims of this study are: 1) To develop, prepare, and implement the MMT PLUS intervention for service providers working with MMT clients in China; 2) To assess feasibility, acceptability, and accessibility of the intervention with process evaluations and participant feedback; 3) To examine primary outcome measures of service providers in the MMT PLUS intervention group, compared to those in the standard care group; 4) To explore secondary outcome measures of clients in the MMT PLUS intervention group, compared to those in the standard care group.

The study will be conducted in Sichuan province of China in two phases. In phase 1, we will conduct two focus groups with 12 service providers and 10 clients in 2 MMT clinics respectively followed by a separate assessment survey to collect necessary information for preparation of phase 2. In phase 2, we will recruit 75 clients and 15 service providers, respectively, in 3 standard care clinics and 3 clinics with MMT PLUS intervention. Intervention will be conducted with the service providers only in 3 MMT plus intervention clinics but not in MMT standard care clinics. The results will be compared between 2 groups of MMT clinics via evaluation on primary outcome of service providers and secondary outcome of IDU by the impact of primary outcome from providers. Assessments will be measured through baseline questionnaires and follow-up questionnaires at 3, 6, 9 months from the providers and clients, as well as urine tests and medical examination of clients.

Targeted Risk Group: 

IDUs undergoing MMT treatment, MMT clinic service providers.

Intervention model: 

Cognitive Behavior, Stage of Change, and Motivational interviewing

Research Methods:

• Focus groups with 10 providers and 10 clients in two MMT clinics
• Implement MMT PLUS intervention in three MMT clinics, with 15 providers and 75 MMT clients
• Trained providers will conduct motivational interviewing sections with their clients
• Outcome assessments will be conducted at baseline, 3-, 6-, 9-month follow-ups.

Local Significance: 

Capacity building for service providers working at the MMT clinics in China; Findings from the pilot will make important contributions to the success and sustainability of MMT, and related policy making in China.

International Significance: 

Even though methadone treatment is widely used for decades, there is a lack of integrating psychosocial and behavioral components with a culturally-relevant focus. Findings from this study will provide practical implementations guidelines for agencies within and outside of China.