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.
• Medication for opioid use disorder (MOUD), including methadone maintenance therapy (MMT), is crucial for treatment.
• Decentralized MMT models aim to enhance access and client-centered care, but their implementation in Africa requires further investigation.

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 through community health centers.

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) were performed.
• Thematic analysis, guided by the Consolidated Framework for Implementation Research (CFIR), was used to explore experiences and perceptions.

Main Results:

• Advantages included reduced travel time/costs and improved access for clients with obligations.
• Challenges identified across CFIR domains included perceived lower quality of care and monitoring at community health centers compared to specialized clinics.
• Barriers also included privacy concerns, stigma, fewer wrap-around services, 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 for successful decentralized MMT.
• These strategies are essential for overcoming barriers and improving OUD treatment in community settings.