title: Integrating antiretroviral therapy in methadone maintenance therapy clinics: service provider perceptions.
abstract: BACKGROUND
  Using methadone maintenance therapy (MMT) clinics to deliver antiretroviral therapy (ART) is an effective strategy to promote treatment initiation and adherence for HIV-positive drug users. This paper describes the implementation barriers perceived by service providers for an intervention pilot designed to integrate ART services in MMT clinics.
  
  
  METHODS
  The study was conducted in six MMT clinics in Sichuan province, China. Two service providers selected from each of the six clinics underwent training in administering ART. The trained providers delivered ART-related services in their clinics. A focus group was conducted among the service providers to assess their experiences and perceived challenges in delivering integrated services.
  
  
  RESULTS
  Barriers at policy, institutional, provider, and client levels were identified. Policy level barriers included household registration restrictions and a lack of insurance coverage for testing expenses. Inefficient coordination between treatment sites and MMT clinics was an obstacle at the institutional level. Insufficient training and added workload were barriers at the provider level. Finally, conflict with daily dosing habits was identified as the primary reason that clients did not accept ART.
  
  
  CONCLUSIONS
  Although integrating ART into MMT clinics is beneficial, multilevel barriers to implementation need to be addressed. This study documents the need for treatment transferability and insurance coverage, protection of client confidentiality, proper provider training, coordination with treatment sites, and individualized ART service for MMT clients.
authors.affiliation: Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California at Los Angeles, Los Angeles, CA, USA. Electronic address: lincq@ucla.edu.
authors.forename: Chunqing
authors.initials: C
authors.lastname: Lin
authors.affiliation: National Center for AIDS Prevention and Control, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Xiaobin
authors.initials: X
authors.lastname: Cao
authors.affiliation: Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California at Los Angeles, Los Angeles, CA, USA.
authors.forename: Li
authors.initials: L
authors.lastname: Li
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D002681:China; D006297:Health Services Accessibility; D006801:Humans; D008691:Methadone / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment; D016320:Substance Abuse Treatment Centers / Q000458:organization & administration*
chemical_list: D044966:Anti-Retroviral Agents; D008691:Methadone
keywords: Antiretroviral therapy; China; Implementation; Methadone maintenance therapy