Screen, Treat and Retain People With Primary Meth Use Disorder at MMT Clinics

Feasibility will be evaluated 1) by recruitment rate for screening at selected methadone clinics and 2) by recruitment rate for the study interventions among those screened. Feasibility is defined as at least 50% of those approached agree to participate in screening and among those eligible at least 50% agree to participate in the study interventions.

Acceptability will be assessed by perceived challenges and facilitators of recruitment and enrollment. Two focus group discussions will be organized with 12-16 participants who support recruitment and 15 in-depth interviews (5 per recruitment strategy) will be conducted with individuals eligible for enrollment and agree or decline to participate in the study interventions. Themes of positive perceptions of recruitment and enrollment are considered indicators of acceptability.

Feasibility is defined by the rate of attendance in intervention sessions, retention in treatment and completion of urine drug screens (UDS). The STAR-OM data indicated that in any given week, approximately 85% of participants attended Matrix sessions and 88% completed UDS visits. Acknowledging the challenges facing people with primary MUD and without OUD in attending intervention sessions at methadone clinics regularly over 12 weeks, the study intervention is deemed feasible if the study reaches 70% of overall intervention attendance and 70% of overall UDS completion.

Acceptability is defined as a common theme of positive perceptions among both participants and providers of providing each type of intervention, behavioral or medication, for people with primary MUD but without OUD at methadone clinics. Acceptability will be assessed through post-intervention in-depth interviews with 15 participants, focus groups with methadone providers who deliver behavioral interventions (N = 1 focus group with 6-8 participants), and in-depth interviews with policy makers at national and city levels (N=5). Acceptability is also defined by 70% of participants indicating that the intervention is agreeable or satisfactory in the 12-week assessment.

Changes in reported meth use and urine drug screen results between baseline and 12-week follow-up. The study team uses Timeline Follow-back method to collect data on the number of meth use days and the cost for meth use in the past 30 days at baseline and at 12-week follow-up visit. Participants undergo one weekly urine drug screen throughout the 12 weeks of intervention.

Changes in the mean scores of each of the subscales in the Depression, Anxiety and Stress Scale version with 21 items (DASS-21) between baseline and 12-month follow-up. DASS-21 has 3 subscales for depression, anxiety and stress. Each subscale has 7 items, rated on a 4-point Likert scale. Scores (after multiplying by 2) range from 0 to 42. Lower scores mean better mental health status.

Changes in HIV status as determined by rapid HIV testing between baseline and 12-week follow-up

HIV sexual risk behaviors related to substance use are measured using Chesney et al. (1997)'s questionnaire. Injection practices in relation to meth use are also inquired. This section consists of 8 questions asking about unprotected sexual behaviors and injection equipment sharing. The unit of measure is percentage of participants indicating yes for each risk behavior.

Feasibility of providing medications at methadone clinics for people with primary methamphetamine use disorder and without opioid use disorder is assessed qualitatively and defined as a common theme of positive perceptions among MMT providers and policy makers (1 focus group with 6-8 MMT providers, and 5 in-depth interviews with policy makers at national and city levels).

Acceptability of providing medications at methadone clinics for people with primary methamphetamine use disorder and without opioid use disorder is assessed qualitatively and defined as a common theme of positive perceptions among MMT providers and policy makers (1 focus group with 6-8 MMT providers, and 5 in-depth interviews with policy makers at national and city levels).