Abstract:
Introduction
Contingency management in addiction behaviors has been widely applied in high income
settings. Contingency management entails modification of behavior via the control or
manipulation of consequences (contingencies) to the behavior. While a need exists for
contingency management in low- and middle- income settings, specifically those of the
sub-Saharan Africa region, uptake is low relative to high income settings. This study assessed barriers to implementation of contingency management for methadone treatment clients at the outpatient clinic of a tertiary hospital in Tanzania.
Methods
This study employed a qualitative design and was conducted at Mbeya Zonal Referral
Hospital (MZRH). Guided by the consolidated framework of implementation research
(CFIR), data were collected from two sources 1) ten purposively selected key informants
(health care workers, methadone treatment clients and hospital leaders) who participated in in-depth interviews, and 2) a mini focus group discussion with five participants
(two health care providers, two hospital leaders and one leader of methadone treatment
clients). We developed semi-structured guides for in-depth interviews and the mini focus
group to explore the key barriers. We analyzed the collected data using thematic analysis.
Results
Reported barriers revolved around the following key themes: lack of awareness and knowledge regarding contingency management, financial constraints to support implementation, trust between clients and health care workers, Health care workers work load, client behaviors and clinic culture. Participants mentioned lack of awareness and knowledge more frequently compared to other themes.
Conclusion
In the context of specialized outpatient care in Tanzania, contingency management faces
a variety of barriers. Deliberate efforts to establish and sustain contingency management
in these settings require strategies that attend to the identified barriers. If the barriers are
overcome, contingency management implementation and sustainment may follow and
ultimately improve methadone related health outcome for patients.
