We propose a 5-year randomized controlled trial that targets methadone maintenance treatment (MMT) programs in China. Applying the principles of combination prevention, the proposed intervention (MMT CARE) integrates psychosocial and behavioral components into a pharmacological framework for methadone maintenance. A total of 68 MMT clinics will be randomly selected from four provinces. From each clinic, 6 service providers and 36 clients will be recruited, totaling 408 providers and 2,448 clients in the study. The 68 clinics will be randomized to: 1) a MMT CARE intervention group, or 2) a control group (34 clinics each). Service providers who complete the training will conduct three individual motivational enhancement sessions with clients. Efficacy of the intervention will be evaluated at baseline and at 3, 6, 12, 18, and 24-month follow- ups. The outcomes for service providers will be measured by: 1) improved adherence to MMT protocols;2) decreased prejudicial attitudes;3) increased interaction with clients;and 4) increased communications with clients about risk reduction. The outcomes for clients will be measured by: 1) improved treatment adherence/retention;2) decreased concurrent drug use;3) increased motivation for behavior change;4) improved mental health;5) increased positive support;and 6) reduced HIV risk behaviors.

Public Health Relevance

Injecting drug use is a hidden dimension of the global HIV epidemic. China's methadone maintenance therapy (MMT) program is expanding rapidly to address a critical link between drug abuse and HIV/AIDS. However, it faces multiple challenges, including a high dropout rate, high concurrent drug use, and a gap between clients'needs and service providers'skills. This project uses a combination prevention approach to respond to the urgent need for improved quality of services at clinics, provider-client interactions, and client treatment outcomes. Collected data will form the foundation of an evidence-based intervention that can be delivered to over 700 MMT clinics in China, and will potentially serve as a successful model for harm reduction programs in other countries.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Research Project (R01)
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Behavioral and Social Consequences of HIV/AIDS Study Section (BSCH)
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Ducharme, Lori
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University of California Los Angeles
Schools of Medicine
Los Angeles
United States
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Lin, Chunqing; Lan, Chiao-Wen; Li, Li et al. (2018) Service providers' adherence to methadone maintenance treatment protocol in China. Int J Drug Policy 56:1-5
Feng, Nan; Lin, Chunqing; Hsieh, Julie et al. (2018) Family Related Factors and Concurrent Heroin Use in Methadone Maintenance Treatment in China. Subst Use Misuse 53:1674-1680
Lin, Chunqing; Li, Li; Cao, Xiaobin (2017) Client Acceptability for Integrating Antiretroviral Therapy in Methadone Maintenance Therapy Clinics in Sichuan, China. Subst Use Misuse 52:119-126
Li, Li; Liang, Li-Jung; Lin, Chunqing et al. (2017) Comparison Between Urinalysis Results and Self-Reported Heroin Use Among Patients Undergoing Methadone Maintenance Treatment in China. Subst Use Misuse 52:1307-1314
Lin, Chunqing; Cao, Xiaobin; Li, Li (2017) Psychoactive Substance Use among Methadone Maintenance Therapy Clients in China. Int J Ment Health Addict 15:801-811
Li, Li; Comulada, W Scott; Lin, Chunqing et al. (2017) Factors related to client satisfaction with methadone maintenance treatment in China. J Subst Abuse Treat 77:201-206
Li, Li; Comulada, W Scott; Lin, Chunqing et al. (2017) Report on Provider-Client Interaction From 68 Methadone Maintenance Clinics in China. Health Commun 32:1368-1375
Lin, Chunqing; Cao, Xiaobin; Li, Li (2014) Integrating antiretroviral therapy in methadone maintenance therapy clinics: service provider perceptions. Int J Drug Policy 25:1066-70