Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, #74, Zhongshan Road II, Guangzhou 510080, PR China; Sun Yat-sen Center for Migrant Health Policy, #74, Zhongshan Road II, Guangzhou 510080, PR China.
Drug Alcohol Depend. 2013 Nov 1;133(1):270-4. doi: 10.1016/j.drugalcdep.2013.05.028. Epub 2013 Jul 4.
Methadone maintenance treatment (MMT) has been successfully scaled up nationally in China. However, the program faces problems of poor attendance and high rates of continued drug use. We assessed whether a contingency management (CM) intervention implemented by MMT clinic staff could improve treatment attendance and drug abstinence.
Eight MMT clinics in Guangdong province were randomly selected and divided into two groups. A total of 126 participants (55 in urban clinics and 71 in rural clinics) received CM during a 12-week trial, 120 participants (83 in urban clinics and 37 in rural clinics) received usual treatment (UT). Participants in the CM group had the opportunity to draw for prizes contingent on attending treatment daily and testing negative for morphine. Clinic- and individual-level outcomes were compared between the intervention and control groups.
The retention rate and negative urine testing rate were 14.2% (P=0.010) and 10.7% (P<0.001) higher in the CM group compared to the UT group, respectively. Compared with participants who received UT, CM participants missed on average 7.3 fewer (P=0.008) visits and were 1.91 (95% CI: 1.53-2.39) times more likely to submit a negative urine sample. All clinic- and individual- level effects of the intervention were observed at rural clinics, but the difference in retention rate between urban CM and UT clinics was not significant.
Although the frequency of monitoring and value of the incentives in this study was lower than in previous studies, the CM intervention significantly improved attendance and reduced drug use in China.
美沙酮维持治疗（MMT）在中国已成功在全国范围内推广。然而，该项目面临出勤率低和持续吸毒率高的问题。我们评估了由 MMT 诊所工作人员实施的应急管理（CM）干预措施是否可以提高治疗出勤率和戒毒率。
广东省随机选择了 8 家 MMT 诊所，分为两组。共有 126 名参与者（城市诊所 55 名，农村诊所 71 名）在 12 周的试验中接受了 CM，120 名参与者（城市诊所 83 名，农村诊所 37 名）接受了常规治疗（UT）。CM 组的参与者有机会通过每天参加治疗并检测吗啡阴性来抽奖。比较干预组和对照组在诊所和个体层面的结果。
与 UT 组相比，CM 组的保留率和阴性尿液检测率分别高 14.2%（P=0.010）和 10.7%（P<0.001）。与接受 UT 的参与者相比，CM 参与者平均少缺诊 7.3 次（P=0.008），且提交阴性尿液样本的可能性高 1.91 倍（95%CI：1.53-2.39）。干预的所有诊所和个体水平的效果都在农村诊所观察到，但城市 CM 和 UT 诊所的保留率差异不显著。
尽管本研究中监测的频率和激励的价值低于以前的研究，但 CM 干预措施显著提高了出勤率并减少了中国的吸毒行为。
