Who uses methadone services in China? Monitoring the world's largest methadone programme.

AIMS: To describe the data collected by the Chinese methadone maintenance treatment (MMT) system and the characteristics of clients entering the programme. DESIGN: Descriptive study using routinely collected data from the MMT data management system for the period March 2004 and March 2010. SETTING: All MMT clinics in China. PARTICIPANTS: Clients who enrolled for services between March 2004 and March 2010. MEASUREMENTS: Routinely collected data included: demographic information; drug use, sexual and criminal behaviours; status of infection with human immunodeficiency virus (HIV), hepatitis C virus (HCV) and syphilis; random urine-opiate test results; and the daily methadone dose received. Differences among clients by year were examined. FINDINGS: During the period examined, there were 251,974 clients attending 684 clinics in 27 provinces. Overall, the mean age was 34.4 years, 83.8% were male, 70.2% were unemployed, 75% had ever injected drugs, 17% had shared needles and 7.4% were HIV-positive. The profile of clients changed over time, with fewer HIV-positive individuals, fewer injecting drug users, fewer needle-sharers, fewer females and fewer unemployed. Half the clients dropped out within 6 months. The average final dose received was 49.4 mg. The estimated probability of interrupting treatment before 6 months was 52.5%. CONCLUSIONS: The profile of clients enrolling in methadone maintenance treatment in China is continually changing and appears to be associated with reduced risk of HIV. High dropout in the programme may limit its effectiveness. The availability of a centralized, real-time data system was extremely useful for monitoring the progress of the Chinese methadone maintenance treatment programme.

[Health education needs for malaria control in rural residents in Hai'an County].

OBJECTIVE: To understand the status of knowledge, attitudes and practices (KAP) and health education needs for malaria prevention and treatment of rural residents in Hai'an County. METHODS: Hai'an County was divided into three regions of east, south and north, and the primary and secondary students and residents were selected with the multi-stage sampling method and investigated with questionnaire for the status of KAP and the health education needs of malaria control. The results were analyzed statistically. RESULTS: The awareness rates of malaria transmission, symptoms, prevention knowledge in the residents were significantly higher than those in the students (P < 0.05). The awareness rates of malaria prevention knowledge in the residents had significant differences among the residents with different education levels (P < 0.05), and the education levels were positively correlated with the awareness rates of malaria prevention knowledge. The main ways of rural residents to get their knowledge of malaria control were radio, newspapers, the village doctors, public health bulletin, posters, students, and television caption in order; the main ways of students to get their knowledge of malaria control were television, newspapers, public health bulletin, teachers, radio, and flyers in order. CONCLUSIONS: We should pay full attention to the advantages of mass media to carry out the extensive health education on malaria prevention and control, and should also take into account the different characteristics of the audience.

Challenges in providing services in methadone maintenance therapy clinics in China: service providers' perceptions.

BACKGROUND: The Methadone Maintenance Therapy (MMT) program has been initiated in China since 2004. As of the end of November, 2008, 558 MMT clinics had been established countrywide. The objective of this study was to elucidate the difficulties and challenges as perceived by service providers working in MMT clinics. METHODS: One service provider from each of the 28 MMT study clinics in Zhejiang and Jiangxi Provinces of China participated in a face-to-face in-depth interview for about 1-2h to describe their perceptions of working in MMT clinics. Qualitative data were analysed using ATLAS.ti. The grounded theory was used to guide the data analysis. RESULTS: Participants identified major problems in providing services in MMT clinics including lack of resources, professional training, and institutional support. Difficulties in pursuit of career, concern for personal safety, low income, heavy working load, and poor opinion of MMT by Chinese society often contributed to greater stress and burnout among the service providers. CONCLUSION: The MMT programs in China desperately need additional resource allocation and institutional support for the current and perhaps future expansion of the programs. The service providers are in urgent need of professional training to improve the quality of care they can offer MMT clients.