Implementation Challenges and Opportunities in Decentralized Methadone Service Delivery

Area of Science:

• Public Health
• Substance Abuse Treatment
• Implementation Science

Background:

• Opioid Use Disorder (OUD) is a growing global health challenge, particularly in low- and middle-income countries.
• Decentralized methadone maintenance therapy (MMT) models aim to enhance treatment accessibility and client-centered care.
• Implementation of decentralized MMT in Africa requires understanding client and provider perspectives.

Purpose of the Study:

• To qualitatively examine client and provider perspectives on decentralized methadone service delivery in Tanzania.
• To identify benefits, barriers, and recommendations for implementing decentralized MMT models.

Main Methods:

• A qualitative study was conducted in Dar es Salaam, Tanzania.
• In-depth interviews with 10 providers and four focus groups with 40 participants (clients, outreach workers, treatment supporters).
• Thematic analysis guided by the Consolidated Framework for Implementation Research (CFIR).

Main Results:

• Key benefits included reduced travel time/costs and improved access for clients with obligations.
• Challenges identified across CFIR domains: perceived lower quality of care and fewer wrap-around services at satellite centers.
• Barriers included privacy concerns, stigma, loss of peer support, fears of drug testing, limited client involvement, and unclear communication.

Conclusions:

• Effective implementation requires addressing community stigma and ensuring consistent service quality.
• Supporting clients' social connections and fostering transparent, participatory planning are critical.
• These strategies are essential for successful decentralized methadone service delivery.