title: Human resource development and capacity-building during China's rapid scale-up of methadone maintenance treatment services.
abstract: OBJECTIVE
  China's National Methadone Maintenance Treatment Programme (MMT) has expanded from eight clinics serving approximately 1000 clients to 738 clinics that have served more than 340 000 clients cumulatively in only 8 years. This has created an enormous demand for trained providers.
  
  
  METHODS
  Human resource development and capacity building efforts have been conducted in China's National MMT Programme to create a supply of providers trained in administering MMT for opioid dependence.
  
  
  METHODS
  From 2004 to 2007, China's National MMT Programme faced several problems: inappropriately low methadone doses, poor compliance, high concurrent drug use and high drop-out rates among clients, and little experience, little training and high turnover rates among providers.
  
  
  RESULTS
  Training programmes for individual providers and their trainers were redeveloped and expanded in 2008. Although programme performance metrics show an increase in patients' annual mean duration in treatment (93 days in 2004 versus 238 days in 2011), the increase in their mean daily methadone dose (from 47.2 mg in 2004 to 58.6 mg in 2011) is modest.
  
  
  CONCLUSIONS
  Some of the problems that can arise during the development, launch and scale-up of a major national public health effort, such as China's National MMT Programme, cannot be foreseen. Key to the programme's success so far have been the strong commitment on the part of China's government and the optimism and pragmatism of programme managers. Human resources development and capacity-building during scale-up have contributed to improved service quality in MMT treatment clinics and are critical to long-term success.
authors.affiliation: National Methadone Maintenance Treatment Training Centre, Yunnan Institute of Drug Abuse, Kunming, China.
authors.forename: Jianhua
authors.initials: J
authors.lastname: Li
authors.forename: Changhe
authors.initials: C
authors.lastname: Wang
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: McGoogan
authors.forename: Keming
authors.initials: K
authors.lastname: Rou
authors.forename: Marc
authors.initials: M
authors.lastname: Bulterys
authors.forename: Zunyou
authors.initials: Z
authors.lastname: Wu
mesh_terms: D057191:Capacity Building / Q000379:methods*; D002681:China / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D006282:Health Personnel / Q000193:education*; D006801:Humans; D008691:Methadone / Q000008:administration & dosage / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment / Q000706:statistics & numerical data* / Q000639:trends; D009293:Opioid-Related Disorders / Q000453:epidemiology / Q000534:rehabilitation*; D016320:Substance Abuse Treatment Centers / Q000458:organization & administration* / Q000639:trends; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000453:epidemiology / Q000534:rehabilitation*; D000078329:Workforce
chemical_list: D008691:Methadone
references.citation: Mt Sinai J Med. 2000 Oct-Nov;67(5-6):404-11
references.pmid: 11064491
references.citation: AIDS. 2007 Dec;21 Suppl 8:S103-7
references.pmid: 18172377
references.citation: BMJ. 2012 Oct 03;345:e5945
references.pmid: 23038795
references.citation: J Infect Dis. 2011 Jul 1;204(1):74-83
references.pmid: 21628661
references.citation: Clin Psychol Rev. 2010 Mar;30(2):155-66
references.pmid: 19926374
references.citation: Curr HIV/AIDS Rep. 2010 Nov;7(4):220-5
references.pmid: 20803321
references.citation: Int J Epidemiol. 2010 Dec;39 Suppl 2:ii21-8
references.pmid: 21113033
references.citation: Int J Epidemiol. 2010 Dec;39 Suppl 2:ii29-37
references.pmid: 21113034
references.citation: World J Biol Psychiatry. 2011 Apr;12(3):160-87
references.pmid: 21486104
references.citation: Drug Alcohol Depend. 2011 Aug 1;117(1):45-9
references.pmid: 21310554
references.citation: Cochrane Database Syst Rev. 2009 Jul 08;(3):CD002209
references.pmid: 19588333
references.citation: Int J Drug Policy. 2007 Mar;18(2):118-28
references.pmid: 17689354
references.citation: Int J Drug Policy. 2010 May;21(3):173-8
references.pmid: 19818591
references.citation: Addiction. 2005 Feb;100(2):150-8
references.pmid: 15679744
references.citation: J Subst Abuse Treat. 2010 Mar;38(2):119-27
references.pmid: 20015606