BACKGROUND Moral conservatism within government and communities has resulted in a reluctance to support the provision of opioid agonist therapy for people with opioid use disorders in South Africa. In April 2017, South Africa's first low-threshold opioid agonist therapy demonstration project was launched in Durban. The project provided 54 low-income people with heroin use disorders methadone and voluntary access to psychosocial services for 18 months. At 12 months, retention was 74%, notably higher than the global average. In this paper, we aim to make sense of this outcome. METHODS Thirty semi-structured interviews, two focus groups, ten oral histories and ethnographic observations were done at various project time points. These activities explored participants' pathways into drug use and the project, their meaning attributed to methadone, the factors contributing to project success and changes they experienced. Recordings, transcripts, notes and feedback were reviewed and triangulated. Key factors contributing to retention were identified and analysed in light of the existing literature. RESULTS The philosophy and architecture of the project, and social cohesion were identified as the main factors contributing to retention. The use of a harm reduction approach enabled participants to set and be supported to achieve their treatment goals, and was shown to be important for the development of trusting therapeutic relationships. The employment of a restorative justice paradigm provided a sense of acceptance of humanity and flaws as well as an imperative to act responsibly towards others, fostering a culture of respect. Social cohesion was fostered through the facilitation of group sessions, a peace committee and group sport (soccer). In concert, these activities provided opportunities for participants to demonstrate care and interest in one another's life, leading to interdependence and care, contributing to them remaining in the project. CONCLUSIONS We believe that the high retention was achieved through attraction. We argue that opioid agonist therapy programmes should take the principles of harm reduction and restorative justice into consideration when designing low-threshold opioid agonist therapy services. Additionally, ways to support cohesion amongst people receiving agonist therapy should be explored to support their effective scale-up, both in low-middle income countries and in high-income countries.

中文翻译：

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南非德班阿片类激动剂治疗项目的高保留率：最佳实践和社会凝聚力的作用。


背景技术政府和社区内的道德保守主义导致南非不愿支持为阿片类药物使用障碍患者提供阿片类药物激动剂治疗。 2017年4月，南非首个低阈值阿片激动剂治疗示范项目在德班启动。该项目为 54 名患有海洛因使用障碍的低收入人群提供美沙酮并自愿获得心理社会服务，为期 18 个月。 12 个月时，保留率为 74%，明显高于全球平均水平。在本文中，我们的目标是理解这一结果。方法 在不同的项目时间点进行了三十次半结构化访谈、两个焦点小组、十次口述历史和民族志观察。这些活动探讨了参与者进入药物使用和项目的途径、他们对美沙酮的意义、促成项目成功的因素以及他们经历的变化。录音、文字记录、笔记和反馈都经过审查和三角测量。根据现有文献确定并分析了影响保留的关键因素。结果项目的理念和架构以及社会凝聚力被确定为有助于保留的主要因素。使用减少伤害的方法使参与者能够设定并获得支持以实现他们的治疗目标，并且被证明对于发展信任的治疗关系非常重要。恢复性司法范式的采用提供了一种接受人性和缺陷的意识，以及对他人采取负责任的行动的必要性，从而培育了一种尊重的文化。通过促进小组会议、和平委员会和集体运动（足球），增强了社会凝聚力。 总之，这些活动为参与者提供了展示对彼此生活的关心和兴趣的机会，从而导致相互依赖和关心，有助于他们留在项目中。结论 我们相信高保留率是通过吸引力实现的。我们认为，阿片类激动剂治疗计划在设计低阈值阿片类激动剂治疗服务时应考虑减少伤害和恢复性正义的原则。此外，应探索支持接受激动剂治疗的人们之间的凝聚力的方法，以支持其有效扩大规模，无论是在中低收入国家还是在高收入国家。