Improving access to methadone maintenance treatment in remote areas: A case from Ruili

UNAIDS estimates more than half of the 4.5 million injecting drug users in Asia live in China in 2010. It is estimated that 7%–13% of the people who inject drugs are living with HIV in China in 2007. Tremendous harm and loss of lives were associated with the spread of epidemic. Methadone Maintenance Treatment (MMT) has been widely acknowledged as an effective and efficient method for drug use treatment and HIV harm reduction. Chinese government adopted MMT from 2003 and expanded 600 MMT clinics in 23 provinces till 2008.

Ruili is a remote border city in the southwest China along the heroin trafficking route, where the first 146 cases of HIV infected were detected among intravenous drug users in 1989. The combination of geographic location, mixture of multiple ethnic groups and significant portion of floating population put Ruili under dual threats from HIV/AIDS and drug use. MMT clinics were established in the city to reduce drug use and curb HIV/AIDS transmission. Mobile vans were used as a complement to improve access to MMT services in rural areas as the first practice in China. This study describes the organization structure, treatment procedure, characteristics of the service users, effect and challenges of the MMT clinics and mobile vans, so as to provide recommendations to improve access and sustainability of the service.