Improving Methadone Maintenance Treatment Compliance and Outcomes in China

描述(申请人提供)：中国面临吸毒和艾滋病毒/艾滋病双重流行的挑战。针对海洛因吸毒者中艾滋病毒/艾滋病感染率高和其他医疗后果的担忧，中国最近在全国范围内实施了美沙酮维持治疗计划。这种快速扩张的一个问题是，MMT的辍学率一直很高。中国的MMT很可能受益于循证治疗的强化，特别是在NIDA的临床试验网络中开发和测试的低成本动机激励(MI)干预。心肌梗死干预不需要广泛的培训，可能会被证明对改善中国的MMT依从性和预后特别有用。激励激励办法(应急管理的一种形式)运用了公认的强化和惩罚心理学原则，以改变目标行为(例如，增加出勤率和减少非法药物使用)，方法是操纵因业绩而产生的重要增援人员的临时交付。MI方法尚未应用于接受MMT治疗的中国海洛因成瘾者，目前尚不确定MI是否能减少MMT中国患者的脱落率和阿片类药物的使用。此外，中国MMT独特的文化和环境(如美沙酮剂量、耻辱和社会支持网络)与MI治疗相互作用对MMT结果的影响程度仍有待确定。这项拟议的研究将使美国开发的MI干预措施适用于中国的MMT环境，并将初步测试其在改善治疗依从性和结果方面的有效性。因此，本研究的主要目的是：1.在中国被试中采用激励性激励干预；2.对激励性激励干预进行实验预试。第二个目的是探索可能影响MMT结果的因素，其中包括动机激励干预。如果试点测试的结果是有希望的，该干预可以在更大范围内进行更正式的测试，如果被证明具有临床实用价值，则在中国中广泛应用，以优化MMT在降低海洛因滥用者艾滋病毒风险方面的积极结果。合作团队包括美国和中国机构(加州大学洛杉矶分校/约翰·霍普金斯大学/华盛顿分校、上海精神卫生中心、云南省药物滥用研究所)的研究人员、国家和地方中国疾病控制和预防中心的官员，以及上海和云南当地MMT诊所的提供者。通过在新的人群(中国人)中调整和应用心肌梗死干预措施，拟议的研究将有助于有关心肌梗死的科学文献，并将扩大NIDA发布以研究为基础的干预措施以改善全球治疗服务的使命。公共卫生相关性：这项研究是独特的，也是重要的，因为它将采用基于证据的动机激励干预措施，用于中国的MMT，以增加出席率并帮助维持禁欲。中国面临吸毒和艾滋病毒/艾滋病双重流行的挑战。中国减少吸毒和艾滋病毒/艾滋病将降低这些疾病在世界范围内传播的可能性和相关后果。这项拟议的研究将确定有效的干预措施，帮助解决中国乃至全球的这一重要公共卫生问题。

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.