Evidence map›Paper›PMID 41366379›Full record

ArticleBMC health services research2025

Implementation challenges and opportunities in decentralized methadone service delivery.

Iddi Haruna Nkya, Feaven Gebrezgi, Adela Luswetula, Jessie Mbwambo, Haneefa T Saleem

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Article in BMC health services research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

5 authors.

Iddi Haruna NkyaMuhimbili National Hospital, P.O. Box 65000, Dar es Salaam, Tanzania. idd222@yahoo.co.uk.
Feaven GebrezgiBloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, E5033, Baltimore, MD, 21205, USA.
Adela LuswetulaBloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, E5033, Baltimore, MD, 21205, USA.
Jessie MbwamboMuhimbili National Hospital, P.O. Box 65000, Dar es Salaam, Tanzania.
Haneefa T SaleemBloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, E5033, Baltimore, MD, 21205, USA.

Funding

Understanding the role of social networks in methadone maintenance treatment retention and antiretroviral therapy adherence among people who inject drugs in TanzaniaK01DA047142 · NIDA · JOHNS HOPKINS UNIVERSITY · PI SALEEM, HANEEFA TASLEEM · 2019 to 2023
$968k
NIDA NIH HHS K01 DA047142NIDA NIH HHS K01DA047142
6 · The paper itself

Abstract

backgroundAs the burden of opioid use disorder (OUD) increases in low- and middle-income countries, expanding access to medications for opioid use disorder, including methadone maintenance therapy, is essential. Decentralized models of methadone service delivery aim to improve treatment access, reduce costs for clients and burdens on health systems, and deliver more client-centered care. However, questions remain about the feasibility, acceptability, and implementation of decentralized models for methadone delivery, particularly in Africa. We qualitatively examined client and provider perspectives on decentralized methadone service delivery through community health centers in Tanzania.

methodsWe conducted a qualitative study with in-depth interviews among 10 providers and four focus groups with 40 participants (clients enrolled in OUD care, outreach workers, and treatment supporters) in Dar es Salaam, Tanzania. Through thematic analysis guided by the Consolidated Framework for Implementation Research (CFIR), we explored the experiences and perceptions of decentralized methadone services, including benefits, barriers, and recommendations.

resultsParticipants described key advantages of decentralization, such as reduced travel time and costs, improved access for clients with family or work obligations, and less congestion at central specialized opioid treatment clinic. However, they reported challenges across CFIR domains. Under intervention characteristics, clients perceived lower quality of care and less monitoring at community health centers than at specialized opioid treatment clinics. Outer setting factors, such as privacy concerns and stigma, were perceived barriers to decentralized methadone delivery. Compared with specialized clinics, community health centers have fewer wrap-around services, reinforcing perceptions of poor quality of care. Individual characteristics, such as the risk of losing peer support networks and fears of drug testing, further discouraged clients from desiring to be transferred to community health centers. Finally, limited client involvement in planning and unclear communications were viewed as factors contributing to mistrust and resistance among clients to receive their methadone treatment at a community health center.

conclusionsAddressing community stigma, ensuring consistent service quality, supporting and enhancing clients' social connections, and fostering transparent and participatory planning processes will be critical to effectively implement decentralized methadone service delivery.

Indexed as

MethadoneOpiate Substitution TreatmentOpioid-Related DisordersPoliticsAdultCommunity Health CentersFemaleFocus GroupsHealth Services AccessibilityHumansInterviews as TopicMaleMiddle AgedQualitative ResearchTanzaniaMethadoneAfricaDecentralized service deliveryMedications for opioid use disorderMethadone maintenance therapy

Identifiers

PMID41366379
PMCPMC12802259

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.