Improving Methadone Maintenance Treatment Compliance and Outcomes in China

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DESCRIPTION (provided by applicant): China faces the challenge of dual epidemics of drug use and HIV/AIDS. In responding to concerns of high rates of HIV/AIDS and other medical consequences among heroin users, China has recently implemented methadone maintenance treatment (MMT) programs nationwide. One problem noted with this rapid expansion is that the dropout rates from MMT have been high. MMT in China is likely to benefit from augmentation with evidence-based treatment, particularly the low-cost motivational incentives (MI) intervention developed and tested in NIDA's Clinical Trial Network (CTN). The MI intervention does not require extensive training, and may prove particularly useful for improving MMT compliance and outcomes in China. The motivational incentives approach (a form of contingency management) applies well-established psychological principles of reinforcement and punishment in order to change target behavior (e.g., increase attendance and decrease illicit drug use) by manipulating the contingent delivery of salient reinforcers, occurring as a consequence of performance. The MI approach has not been applied to Chinese heroin addicts treated in MMT and it is yet to be determined if MI can reduce dropout and opiate use among Chinese patients in MMT. Additionally, the degree to which the unique culture and environment in Chinese MMT (e.g., methadone dosage, stigma, and social support network) may interact with MI treatment to influence outcomes of MMT remains to be determined. The proposed study will adapt an MI intervention developed in the United States for use in Chinese MMT settings and will pilot test its effectiveness in improving treatment compliance and outcomes. Thus, the study's primary aims are: 1. to adapt a motivational incentives intervention in MMT in China, and 2. to experimentally pilot test the motivational incentives intervention. A secondary aim is to explore factors that may influence the outcomes of MMT that incorporates a motivational incentives intervention. If the results of pilot testing are promising, the intervention can be more formally tested on a larger scale and, if proven to have clinical utility, applied widely in China to optimize the positive outcomes of MMT in reducing HIV risks among heroin abusers. The collaborative team includes researchers in American and Chinese institutes (UCLA/Johns Hopkins/Washington, Shanghai Mental Health Center, Yunnan Institute for Drug Abuse), officials from national and local Chinese Centers for Disease Control and Prevention, and providers in local MMT clinics in Shanghai and Yunnan. By adapting and applying an MI intervention in a new population (Chinese), the proposed study will contribute to the scientific literature on MI and will extend NIDA's mission to promulgate research-based interventions to improve treatment services globally. PUBLIC HEALTH RELEVANCE: The study is unique and important because it will adapt an evidence-based motivational incentives intervention for use in Chinese MMT to increase attendance and help maintain abstinence. China faces the challenge of dual epidemics of drug use and HIV/AIDS. Reduced drug use and HIV/AIDS in China will decrease the likelihood of spread of these diseases and related consequences worldwide. The proposed study will identify effective interventions that help to address this important public health problem in China and globally.