Limits...
Scaling up the national methadone maintenance treatment program in China: achievements and challenges.

Yin W, Hao Y, Sun X, Gong X, Li F, Li J, Rou K, Sullivan SG, Wang C, Cao X, Luo W, Wu Z - Int J Epidemiol (2010)

Bottom Line: In spite of these difficulties, ongoing evaluation has suggested reductions in heroin use, risky injection practices and, importantly, criminal behaviours among clients, which has thus provided the impetus for further expansion.Cooperation between health and public security officials has improved through regular meetings and dialogue.However, institutional capacity building is still needed to deliver sustainable and standardized services that will ultimately improve retention rates.

View Article: PubMed Central - PubMed

Affiliation: Chinese Center for Disease Control and Prevention, Beijing, China.

ABSTRACT
China's methadone maintenance treatment program was initiated in 2004 as a small pilot project in just eight sites. It has since expanded into a nationwide program encompassing more than 680 clinics covering 27 provinces and serving some 242 000 heroin users by the end of 2009. The agencies that were tasked with the program's expansion have been confronted with many challenges, including high drop-out rates, poor cooperation between local governing authorities and poor service quality at the counter. In spite of these difficulties, ongoing evaluation has suggested reductions in heroin use, risky injection practices and, importantly, criminal behaviours among clients, which has thus provided the impetus for further expansion. Clinic services have been extended to offer clients a range of ancillary services, including HIV, syphilis and hepatitis C testing, information, education and communication, psychosocial support services and referrals for treatment of HIV, tuberculosis and sexually transmitted diseases. Cooperation between health and public security officials has improved through regular meetings and dialogue. However, institutional capacity building is still needed to deliver sustainable and standardized services that will ultimately improve retention rates. This article documents the steps China made in overcoming the many barriers to success of its methadone program. These lessons might be useful for other countries in the region that are scaling-up their methadone programs.

Show MeSH

Related in: MedlinePlus

HIV sentinel surveillance data for drug users, 1995–2009
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC2992615&req=5

Figure 1: HIV sentinel surveillance data for drug users, 1995–2009

Mentions: Under the leadership of Chairman Mao, China experienced a relatively drug-free period between the 1950s and the 1970s.1–5 However, in the late 1970s, the country underwent economic reforms and the illicit drug trade re-emerged, first within the border areas adjacent to the ‘Golden triangle’, then along drug trafficking routes to other parts of the country.2,6,7 In 1989, the first HIV outbreak was identified among 146 injecting drug users in Yunnan province.8 Since then, China has observed an ever-growing HIV/AIDS epidemic, initially fuelled by injecting drug users.9 In 2001, up to 66.5% of newly diagnosed HIV infections were related to drug use.10 Harm reduction efforts began in 2003 and have slowed the pace of HIV infection among drug users;11 HIV prevalence has stabilized and reduced, particularly since 2005 (Figure 1), with the overall growth rate of newly reported cases having decreased from 9.0% in 2006 to 5.8% in 2009.12 However, drug users still represent a major driver of the HIV epidemic in China.Figure 1


Scaling up the national methadone maintenance treatment program in China: achievements and challenges.

Yin W, Hao Y, Sun X, Gong X, Li F, Li J, Rou K, Sullivan SG, Wang C, Cao X, Luo W, Wu Z - Int J Epidemiol (2010)

HIV sentinel surveillance data for drug users, 1995–2009
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC2992615&req=5

Figure 1: HIV sentinel surveillance data for drug users, 1995–2009
Mentions: Under the leadership of Chairman Mao, China experienced a relatively drug-free period between the 1950s and the 1970s.1–5 However, in the late 1970s, the country underwent economic reforms and the illicit drug trade re-emerged, first within the border areas adjacent to the ‘Golden triangle’, then along drug trafficking routes to other parts of the country.2,6,7 In 1989, the first HIV outbreak was identified among 146 injecting drug users in Yunnan province.8 Since then, China has observed an ever-growing HIV/AIDS epidemic, initially fuelled by injecting drug users.9 In 2001, up to 66.5% of newly diagnosed HIV infections were related to drug use.10 Harm reduction efforts began in 2003 and have slowed the pace of HIV infection among drug users;11 HIV prevalence has stabilized and reduced, particularly since 2005 (Figure 1), with the overall growth rate of newly reported cases having decreased from 9.0% in 2006 to 5.8% in 2009.12 However, drug users still represent a major driver of the HIV epidemic in China.Figure 1

Bottom Line: In spite of these difficulties, ongoing evaluation has suggested reductions in heroin use, risky injection practices and, importantly, criminal behaviours among clients, which has thus provided the impetus for further expansion.Cooperation between health and public security officials has improved through regular meetings and dialogue.However, institutional capacity building is still needed to deliver sustainable and standardized services that will ultimately improve retention rates.

View Article: PubMed Central - PubMed

Affiliation: Chinese Center for Disease Control and Prevention, Beijing, China.

ABSTRACT
China's methadone maintenance treatment program was initiated in 2004 as a small pilot project in just eight sites. It has since expanded into a nationwide program encompassing more than 680 clinics covering 27 provinces and serving some 242 000 heroin users by the end of 2009. The agencies that were tasked with the program's expansion have been confronted with many challenges, including high drop-out rates, poor cooperation between local governing authorities and poor service quality at the counter. In spite of these difficulties, ongoing evaluation has suggested reductions in heroin use, risky injection practices and, importantly, criminal behaviours among clients, which has thus provided the impetus for further expansion. Clinic services have been extended to offer clients a range of ancillary services, including HIV, syphilis and hepatitis C testing, information, education and communication, psychosocial support services and referrals for treatment of HIV, tuberculosis and sexually transmitted diseases. Cooperation between health and public security officials has improved through regular meetings and dialogue. However, institutional capacity building is still needed to deliver sustainable and standardized services that will ultimately improve retention rates. This article documents the steps China made in overcoming the many barriers to success of its methadone program. These lessons might be useful for other countries in the region that are scaling-up their methadone programs.

Show MeSH
Related in: MedlinePlus