title: Impact of blended treatment literacy and psychoeducation on methadone maintenance treatment outcomes in Yunnan, China.
abstract: BACKGROUND
  Outcomes of methadone maintenance treatment (MMT) in the management of opioid dependency can be impaired by poor adherence and retention, concomitant drug use, poor adjustment of methadone dosage, and low levels of awareness regarding methadone among drug users, among other factors. This study investigated the effects of intensive blended treatment literacy and psychoeducation on treatment compliance, methadone dose, and heroin use among MMT clients in China.
  
  
  METHODS
  A total of 492 MMT clients who tested positive for urine morphine at least once during a 12-week intervention period preceding the study were recruited from 16 MMT clinics. Employing a client-centred approach, a blended treatment literacy and psychoeducation intervention was then implemented between March and June 2014, comprising (1) intensified methadone treatment literacy sessions; (2) participatory goal setting; (3) continuous adherence monitoring and support; and (4) engagement of both peers and doctors in delivering psychoeducation. Wilcoxon signed-rank test was used to compare urine morphine positive rates, daily methadone dosage, and the number of days that clients successfully accessed methadone before and during the intervention.
  
  
  RESULTS
  During the intervention, urine morphine positive rates reduced to 27% from 49.3% previously; p < 0.001. In response to client needs, methadone dosages increased among 74% of participants, remained unchanged among 12.0%, and reduced among 13.4% during the intervention. In addition, the average daily methadone dose increased from 63.0 to 72.6 mg; p < 0.001, while the average number of days that clients successfully accessed methadone increased from 69.4 to 73.9 over a period of 12 weeks; p < 0.001.
  
  
  CONCLUSIONS
  Blended treatment literacy and psychoeducation delivered by a combination of peers and doctors was associated with reduced heroin use, improved treatment adherence, and higher methadone doses among our sample of MMT clients.
authors.affiliation: Yunnan Institute of Drug Abuse (YIDA), 300 Wujiadui, Xihuayuan, Xishan District, Kunming, Yunnan, China. zhangbo407@126.com.
authors.forename: Bo
authors.initials: B
authors.lastname: Zhang
authors.affiliation: AIDS Care China, R 201, #17 Rongyuan, Jinjiang Residential Quarter, Bejing Road, Panlong District, Kunming, Yunnan, China. thomas@aidscarechina.org.
authors.forename: Thomas
authors.initials: T
authors.lastname: Cai
authors.affiliation: AIDS Care China, R 201, #17 Rongyuan, Jinjiang Residential Quarter, Bejing Road, Panlong District, Kunming, Yunnan, China. zhyan@aidscarechina.org.
authors.forename: Zhihua
authors.initials: Z
authors.lastname: Yan
authors.affiliation: International HIV/AIDS Alliance, 91-101 Davigdor Road, Hove, BN3 1RE, UK. gmburu@aidsalliance.org.|Department of Health Research, Lancaster University, Lancaster, LA1 4YW, UK. gmburu@aidsalliance.org.
authors.forename: Gitau
authors.initials: G
authors.lastname: Mburu
authors.affiliation: International HIV/AIDS Alliance, 91-101 Davigdor Road, Hove, BN3 1RE, UK. gmburu@aidsalliance.org.
authors.forename: Bangyuan
authors.initials: B
authors.lastname: Wang
authors.affiliation: Yunnan Institute of Drug Abuse (YIDA), 300 Wujiadui, Xihuayuan, Xishan District, Kunming, Yunnan, China. ylp412@126.com.
authors.forename: Liping
authors.initials: L
authors.lastname: Yang
mesh_terms: D000328:Adult; D002681:China; D003131:Combined Modality Therapy; D005260:Female; D006556:Heroin Dependence; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008691:Methadone / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D009020:Morphine / Q000652:urine; D009294:Narcotics / Q000008:administration & dosage / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment / Q000379:methods*; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D010353:Patient Education as Topic; D010379:Peer Group; D010820:Physicians; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D009294:Narcotics; D009020:Morphine; D008691:Methadone