| Background. The Methadone Maintenance Therapy (MMT) program was established in China in 2004. On the basis of the success of the pilots, the program was scaled up. As of November 30, 2008, 558 MMT clinics had been established nationwide in 23 provinces, and were cumulatively treating more than 170,000 clients. However, given its recent emergence, the MMT program in China also presents special challenges, such as low overall coverage and retention rates. The primary aim of this study was to identify structural level factors that influence client recruitment and retention in MMT clinics in China.;Methods. Between January and July 2008, 30 drug users and 28 service providers completed qualitative in-depth interviews to determine drug users' perceived barriers to seeking MMT and service providers' perceived difficulties with working in MMT clinics. A cross-sectional survey was conducted among 560 randomly selected clients from 28 MMT clinics. Urine specimens were tested for concurrent illicit drug use.;Results. Requirement for registration in the police department, perceived societal stigma, logistic difficulties, side effects, inappropriate perception of methadone, fear of being addicted to another drug, lack of additional services, and economic burden were deterrents for MMT initiation and retention. Service providers cited financial difficulties, lack of professional training, difficulties in pursuit of career, lack of institutional support, concern for personal safety, low income, large working load, and misunderstanding by society as challenges for working in MMT clinics. The quantitative survey found that clinics affiliated with local CDCs had more clients, higher retention rates, and broader coverage than non-CDC-affiliated clinics. Longer operating hours, incentives for compliant clients, and a comprehensive program were positively correlated with client recruitment and coverage. Comprehensive services and incentives for compliant clients were negatively associated with concurrent illicit drug use.;Conclusions. Structural changes need to be made for successful implementation of MMT programs in China. A simplified application procedure, an enhanced referral system, and extended operating hours should help to increase the number of clients and reduce the drop-out rate. Comprehensive services and incentives for compliant clients should be incorporated into the MMT program. |
