Study participants
MMT patients
There were 14 MMT clinics in Shanghai located in urban areas. Since the final aim of the proposal was to evaluate the effectiveness of HCV/HIV comprehensive interventions among drug users in MMT clinics, we defined any MMT clinic with more than 100 patients as meeting the inclusion criteria. There were nine MMT clinics that met the criteria, and four of them were randomly selected. At each selected clinic, the study was explained to potential participants during the recruitment process. For those who decided to participate in this study, detailed informed consent procedures outlined the nature of participation, risks, and benefits.
The patient eligibility criteria included opiate dependence (according to the criteria established by the Diagnostic and Statistical Manual IV, DSM-IV), at least 20 years of age or older, and being local residents. Sixty patients were randomly selected at each clinic for a total of 240 patients. All participants provided informed consent and were paid for their time.
The study participants were asked to respond to questions involving their socio-demographics, risk behaviors, and attitudes towards HCV-related services. They also provided consent to share clinical records and medical test results including drug use and HAV, HBV, and HCV. The research staff provided support for participants who may have had challenges with comprehending study procedures or questionnaires.
MMT staff
Drug abuse treatment staff who currently work at Shanghai MMT clinics were invited to participate in this survey via flyers posted in their offices and mailed to their institutes. To be eligible, staff had to have been working in the MMT program for at least 1 year. There were no other screening criteria for service providers. A total of 58 MMT staff were invited from 14 MMT clinics in Shanghai.
The research protocol was approved by the Ethics Committee of the Shanghai Mental Health Center, and each subject signed the informed consent form approved by IRB at the Shanghai Mental Health Center.
Instruments and measures
Demographics for both patients and MMT staff and drug use history for patients were collected via a self-developed questionnaire.
Risk behaviors survey
An abbreviated version of the risk behaviors assessment developed by the National Institute on Drug Abuse (NIDA) was used; it is used to measure the risk behaviors related to HIV and HCV. Risk behaviors in the areas of drug use and sex in the previous 30 days were measured. Reliability and validity assessments of the risk behaviors survey (RBS) support its adequacy as a research tool for populations of drug users [12,13,14].
HCV knowledge questionnaire
HCV knowledge questionnaire includes 20 items concerning HCV transmission risk and risk behaviors, HCV diagnosis and disease progression, current HCV treatment options, and treatment outcomes. One point is given for each correct answer with a possible score ranging from 0 to 20. The instrument was translated into Chinese by one psychiatrist and back-translated by another psychiatrist, and it has been used in other studies with the same background [15,16,17].
The Alcohol Use Disorder Identification Test
The Alcohol Use Disorder Identification Test (AUDIT) was developed by the WHO to identify hazardous and harmful alcohol use and dependence, and it was specifically designed for international use [18]. This questionnaire consists of ten items to measure the quantity and frequency of alcohol use, possible dependence symptoms, and recent and lifetime problems associated with alcohol use. AUDIT was translated and validated in Chinese [19]. Alcohol consumption is an important factor in HCV infection prevention and treatment. Alcohol use may increase the risk of engaging in unprotected sex behaviors but can also exacerbate steatosis.
HCV-related services survey (for patients)
Perceptions of patients regarding HCV services were evaluated. The patients were asked to respond to a series of questions concerning HCV-related education, HCV/HIV testing, and medical support services in their current treatment programs. They were asked to indicate the extent on a scale from 1 (do not agree at all) to 10 (completely agree) concerning the reason for using these services. Some of questions required a “Yes” or “No” response.
HCV-related services survey (for MMT staff)
A self-developed questionnaire was used to collect information of HCV-related services provided by their treatment programs. It included HCV-related training, HCV testing, and HCV medical treatment support. All questions had “Yes” or “No” as responses.
Beck Depression Inventory
Depressive symptoms were screened with the Chinese version of the 21-item Beck Depression Inventory. Each item is scored from 0 to 3 with a maximum score of 63 [20]. In this study, Beck Depression Inventory (BDI) was used to investigate the depression situation among MMT patients.
HCV tests are part of the routine procedure in MMT clinics in China. HCV serostatus was tested by enzyme-linked immunosorbent assay (ELISA) in there. We obtained HIV, HAV, HBV, and HCV test results from the MMT clinic records with the permission of the participants and the clinic.
Statistical analyses
Statistical Product and Service Solutions 20.0 (SPSS 20.0) was used to conduct the statistical analyses. Continuous data are presented as the mean and SD. Between-group differences for continuous variables were evaluated using Student’s t test. Between-group comparisons for categorical variables were performed using the chi-square test or Fisher’s exact test when necessary.