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Ooms GI, van Oirschot J, de Kant D, van den Ham HA, Mantel-Teeuwisse AK, Reed T. Barriers to accessing internationally controlled essential medicines in sub-saharan Africa: A scoping review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 118:104078. [PMID: 37276779 DOI: 10.1016/j.drugpo.2023.104078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 05/14/2023] [Accepted: 05/22/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Access to internationally controlled essential medicines (ICEMs), medicines that are listed on both the World Health Organization's Essential Medicines List and one of three international drug control conventions, remains problematic in Sub-Saharan Africa (SSA). Previous reviews have focused only on specific ICEMs or ICEM-related healthcare fields, but none have focused on all ICEMs as a distinct class. This scoping review therefore aims to identify the barriers to accessing ICEMs across all relevant healthcare fields in SSA. METHODS A scoping review was conducted across indexing platforms Embase, PubMed, Scopus and Web of Science of studies published between January 1 2012 and February 1 2022. Articles were eligible if they mentioned barriers to accessing ICEMs and/or ICEM-related healthcare fields, if studies were conducted in SSA, or included data on an SSA country within a multi-country study. The review was guided by the Access to Medicines from a Health System Perspective framework. RESULTS The search identified 5519 articles, of which 97 met the inclusion criteria. Many barriers to access were reported and were common across the ICEMs drug class. Main barriers were: at the individual level, the lack of knowledge about ICEMs; at the health service delivery level, low availability, stockouts, affordability, long distances to health facilities, insufficient infrastructure to store and distribute ICEMs, and lack of ICEM knowledge and training among healthcare workers; at the health sector level, lack of prioritisation of ICEM-related healthcare fields by governments and subsequent insufficient budget allocation. Cross-cutting, governance-related barriers pertained to lack of proper quantification systems, cumbersome procurement processes, and strict national laws controlling ICEMs, leading to overly restrictive prescription practices. CONCLUSION This review showed that there are a multitude of barriers to accessing ICEMs in SSA across all health system levels. Many of the barriers identified are applicable to all ICEMs, highlighting the importance of tackling barriers for this entire class of drugs together.
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Affiliation(s)
- Gaby I Ooms
- Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands; Health Action International, Amsterdam, the Netherlands.
| | | | | | - Hendrika A van den Ham
- Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
| | - Aukje K Mantel-Teeuwisse
- Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
| | - Tim Reed
- Health Action International, Amsterdam, the Netherlands
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Wang M, Violette LR, Dorward J, Ngobese H, Sookrajh Y, Bulo E, Quame-Amaglo J, Thomas KK, Garrett N, Drain PK. Delivery of Community-based Antiretroviral Therapy to Maintain Viral Suppression and Retention in Care in South Africa. J Acquir Immune Defic Syndr 2023; 93:126-133. [PMID: 36796353 PMCID: PMC7614548 DOI: 10.1097/qai.0000000000003176] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 01/04/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND To determine whether the Centralized Chronic Medication Dispensing and Distribution (CCMDD) program in South Africa's differentiated ART delivery model affects clinical outcomes, we assessed viral load (VL) suppression and retention in care between patients participating in the program and those receiving the clinic-based standard of care. METHODS Clinically stable people living with HIV (PLHIV) eligible for differentiated care were referred to the national CCMDD program and followed up for up to 6 months. In this secondary analysis of trial cohort data, we estimated the association between routine patient participation in the CCMDD program and their clinical outcomes of viral suppression (<200 copies/mL) and retention in care. RESULTS Among 390 PLHIV, 236 (61%) were assessed for CCMDD eligibility; 144 (37%) were eligible, and 116 (30%) participated in the CCMDD program. Participants obtained their ART in a timely manner at 93% (265/286) of CCMDD visits. VL suppression and retention in care was very similar among CCMDD-eligible patients who participated in the program compared with patients who did not participate in the program (aRR: 1.03; 95% CI: 0.94-1.12). VL suppression alone (aRR: 1.02; 95% CI: 0.97-1.08) and retention in care alone (aRR: 1.03; 95% CI: 0.95-1.12) were also similar between CCMDD-eligible PLHIV who participated in the program and those who did not. CONCLUSION The CCMDD program successfully facilitated differentiated care among clinically stable participants. PLHIV participating in the CCMDD program maintained a high proportion of viral suppression and retention in care, indicating that community-based ART delivery model did not negatively affect their HIV care outcomes.
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Affiliation(s)
- Melody Wang
- Department of Global Health, University of Washington, Seattle, WA
| | - Lauren R Violette
- Department of Medicine, University of Washington, Seattle, WA
- Department of Epidemiology, University of Washington, Seattle, WA
| | - Jienchi Dorward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, United Kingdom
| | - Hope Ngobese
- eThekwini Municipality Health Unit, eThekwini Municipality, Durban KwaZulu-Natal, South Africa
| | - Yukteshwar Sookrajh
- eThekwini Municipality Health Unit, eThekwini Municipality, Durban KwaZulu-Natal, South Africa
| | - Elliot Bulo
- eThekwini Municipality Health Unit, eThekwini Municipality, Durban KwaZulu-Natal, South Africa
| | | | | | - Nigel Garrett
- Centre for the AIDS Program of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Paul K Drain
- Department of Global Health, University of Washington, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
- Department of Epidemiology, University of Washington, Seattle, WA
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Stone J, Fraser H, Walker JG, Mafirakureva N, Mundia B, Cleland C, Bartilol K, Musyoki H, Waruiru W, Ragi A, Bhattacharjee P, Chhun N, Lizcano J, Akiyama MJ, Cherutich P, Wisse E, Kurth A, Luhmann N, Vickerman P. Modelling the impact of HIV and hepatitis C virus prevention and treatment interventions among people who inject drugs in Kenya. AIDS 2022; 36:2191-2201. [PMID: 36111533 PMCID: PMC9671825 DOI: 10.1097/qad.0000000000003382] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 04/11/2022] [Accepted: 04/19/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES People who inject drugs (PWID) in Kenya have high HIV (range across settings: 14-26%) and hepatitis C virus (HCV; 11-36%) prevalence. We evaluated the impact of existing and scaled-up interventions on HIV and HCV incidence among PWID in Kenya. DESIGN HIV and HCV transmission model among PWID, calibrated to Nairobi and Kenya's Coastal region. METHODS For each setting, we projected the impact (percent of HIV/HCV infections averted in 2020) of existing coverages of antiretroviral therapy (ART; 63-79%), opioid agonist therapy (OAT; 8-13%) and needle and syringe programmes (NSP; 45-61%). We then projected the impact (reduction in HIV/HCV incidence over 2021-2030), of scaling-up harm reduction [Full harm reduction ('Full HR'): 50% OAT, 75% NSP] and/or HIV (UNAIDS 90-90-90) and HCV treatment (1000 PWID over 2021-2025) and reducing sexual risk (by 25/50/75%). We estimated HCV treatment levels needed to reduce HCV incidence by 90% by 2030. RESULTS In 2020, OAT and NSP averted 46.0-50.8% (range of medians) of HIV infections and 50.0-66.1% of HCV infections, mostly because of NSP. ART only averted 12.9-39.8% of HIV infections because of suboptimal viral suppression (28-48%). Full HR and ART could reduce HIV incidence by 51.5-64% and HCV incidence by 84.6-86.6% by 2030. Also halving sexual risk could reduce HIV incidence by 68.0-74.1%. Alongside full HR, treating 2244 PWID over 2021-2025 could reduce HCV incidence by 90% by 2030. CONCLUSION Existing interventions are having substantial impact on HIV and HCV transmission in Kenya. However, to eliminate HIV and HCV, further scale-up is needed with reductions in sexual risk and HCV treatment.
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Affiliation(s)
- Jack Stone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol
| | - Hannah Fraser
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol
| | - Josephine G. Walker
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol
| | | | | | | | | | | | - Wanjiru Waruiru
- Global Programs for Research and Training, Surveillance Department, University of California San Francisco, San Francisco, California, USA
| | | | | | - Nok Chhun
- Yale University School of Nursing, New Haven, Connecticut
| | - John Lizcano
- Yale University School of Nursing, New Haven, Connecticut
| | - Matthew J. Akiyama
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | | | - Ann Kurth
- Yale University School of Nursing, New Haven, Connecticut
| | - Niklas Luhmann
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, Bristol, UK
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Haldane V, Jung AS, De Foo C, Shrestha P, Urdaneta E, Turk E, Gaviria JI, Boadas J, Buse K, Miranda JJ, Strathdee SA, Barratt A, Kazatchkine M, McKee M, Legido-Quigley H. Integrating HIV and substance misuse services: a person-centred approach grounded in human rights. Lancet Psychiatry 2022; 9:676-688. [PMID: 35750060 DOI: 10.1016/s2215-0366(22)00159-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/19/2022] [Accepted: 04/19/2022] [Indexed: 12/13/2022]
Abstract
Integrating HIV-related care with treatment for substance use disorder provides an opportunity to better meet the needs of people living with these conditions. People with substance use disorder are rendered especially vulnerable by prevailing policies, structural inequalities, and stigmatisation. In this Series paper we analyse existing literature and empirical evidence from scoping reviews on integration designs for the treatment of HIV and substance use disorder, to understand barriers to and facilitators of care integration and to map ways forward. We discuss how approaches to integration address two core gaps in current models: a failure to consider human rights when incorporating the perspectives of people living with HIV and people who use drugs, and a failure to reflect critically on structural factors that determine risk, vulnerability, health-care seeking, and health equity. We argue that successful integration requires a person-centred approach, which is grounded in human rights, treats both concerns holistically, and reconnects with underlying social, economic, and political inequalities.
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Affiliation(s)
- Victoria Haldane
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Anne-Sophie Jung
- School of Politics and International Studies, University of Leeds, Leeds, UK.
| | - Chuan De Foo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; National University Health System, Singapore
| | - Pami Shrestha
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; National University Health System, Singapore
| | | | - Eva Turk
- Institute for Health and Society, University of Oslo, Oslo, Norway; Medical Faculty, University of Maribor, Maribor, Slovenia
| | - Juan I Gaviria
- Coordinación de Vigilancia Epidemiologica e Infectologia, Hospital del Instituto Ecuatoriano del Seguro Social (IESS) Sur de Quito, Quito, Ecuador
| | - Jesus Boadas
- Centro de Rehabilitación Mental ANSALUD, Santo Domingo, Dominican Republic
| | - Kent Buse
- The George Institute for Global Health, Imperial College London, London, UK
| | - J Jaime Miranda
- Universidad Peruana Cayetano Heredia, Lima, Peru; The George Institute for Global Health, UNSW, Sydney, NSW, Australia
| | | | - Ashley Barratt
- Positive21, London, UK; ReShape/International HIV Partnerships-European Chemsex Forum, London, UK
| | | | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; National University Health System, Singapore; Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Jaguga F, Kiburi SK, Temet E, Barasa J, Karanja S, Kinyua L, Kwobah EK. A systematic review of substance use and substance use disorder research in Kenya. PLoS One 2022; 17:e0269340. [PMID: 35679248 PMCID: PMC9186181 DOI: 10.1371/journal.pone.0269340] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 05/18/2022] [Indexed: 12/27/2022] Open
Abstract
Objectives The burden of substance use in Kenya is significant. The objective of this
study was to systematically summarize existing literature on substance use
in Kenya, identify research gaps, and provide directions for future
research. Methods This systematic review was conducted in line with the PRISMA guidelines. We
conducted a search of 5 bibliographic databases (PubMed, PsychINFO, Web of
Science, Cumulative Index of Nursing and Allied Professionals (CINAHL) and
Cochrane Library) from inception until 20 August 2020. In addition, we
searched all the volumes of the official journal of the National Authority
for the Campaign Against Alcohol & Drug Abuse (the African Journal of
Alcohol and Drug Abuse). The results of eligible studies have been
summarized descriptively and organized by three broad categories including:
studies evaluating the epidemiology of substance use, studies evaluating
interventions and programs, and qualitative studies exploring various themes
on substance use other than interventions. The quality of the included
studies was assessed with the Quality Assessment Tool for Studies with
Diverse Designs. Results Of the 185 studies that were eligible for inclusion, 144 investigated the
epidemiology of substance use, 23 qualitatively explored various substance
use related themes, and 18 evaluated substance use interventions and
programs. Key evidence gaps emerged. Few studies had explored the
epidemiology of hallucinogen, prescription medication, ecstasy, injecting
drug use, and emerging substance use. Vulnerable populations such as
pregnant women, and persons with physical disability had been
under-represented within the epidemiological and qualitative work. No
intervention study had been conducted among children and adolescents. Most
interventions had focused on alcohol to the exclusion of other prevalent
substances such as tobacco and cannabis. Little had been done to evaluate
digital and population-level interventions. Conclusion The results of this systematic review provide important directions for future
substance use research in Kenya. Systematic review registration PROSPERO: CRD42020203717.
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Affiliation(s)
- Florence Jaguga
- Department of Mental Health, Moi Teaching & Referral Hospital,
Eldoret, Kenya
- * E-mail:
| | | | - Eunice Temet
- Department of Mental Health & Behavioral Sciences, Moi University
School of Medicine, Eldoret, Kenya
| | - Julius Barasa
- Population Health, Academic Model Providing Access to Healthcare,
Eldoret, Kenya
| | - Serah Karanja
- Department of Mental Health, Gilgil Sub-County Hospital, Gilgil,
Kenya
| | - Lizz Kinyua
- Intensive Care Unit, Aga Khan University Hospital, Nairobi,
Kenya
| | - Edith Kamaru Kwobah
- Department of Mental Health, Moi Teaching & Referral Hospital,
Eldoret, Kenya
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Mbogo LW, Sambai B, Monroe-Wise A, Ludwig-Barron NT, Guthrie BL, Bukusi D, Chohan B, Macharia P, Dunbar M, Juma E, Sinkele W, Gitau E, Tseng AS, Bosire R, Masyuko S, Musyoki H, Temu TM, Herbeck J, Farquhar C. Participation in methadone programs improves antiretroviral uptake and HIV viral suppression among people who inject drugs in Kenya. J Subst Abuse Treat 2022; 134:108587. [PMID: 34391587 PMCID: PMC11225265 DOI: 10.1016/j.jsat.2021.108587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/28/2021] [Accepted: 07/28/2021] [Indexed: 10/25/2022]
Abstract
BACKGROUND HIV prevalence among people who inject drugs (PWID) in Kenya is estimated to be 18% compared to 4.5% in the general population. Studies from high-income countries have demonstrated that methadone use is associated with increased uptake of antiretroviral therapy (ART) and higher rates of viral suppression among PWID with HIV. However, it is unclear whether methadone use has the same effect among African PWID living with HIV. METHODS We performed a cross-sectional study to evaluate associations between methadone program participation and ART uptake and viral suppression (HIV RNA viral load <1000 copies/ml) among PWID with HIV in Kenya. Participants were recruited from needle and syringe programs and methadone clinics, interviewed on site, and samples were obtained and assayed for HIV viral loads. Univariate and multiple logistic regression were used to determine associations. RESULTS Among 679 participants, median age was 37 years, 48% were female, and 24% were in a methadone program. We observed higher proportions of ART use (96% vs. 87%, p = 0.001) and HIV viral suppression (78% vs. 65%, p = 0.012) among PWID on methadone compared to those not on methadone treatment. PWID who were not participating in a methadone program were 3-fold more likely to be off ART and approximately twice as likely to be viremic compared to those in methadone programs (adjusted odds ratio [aOR] = 3.35, 95% confidence interval [CI]: 1.35-8.35 and aOR = 1.90, 95% CI: 1.03-3.52, respectively). CONCLUSIONS In this study, Kenyan PWID living with HIV participating in a methadone treatment program were more likely to be on ART and to have achieved viral suppression. Scale-up of methadone programs may have a positive impact on HIV epidemic control for this key population.
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Affiliation(s)
- Loice W Mbogo
- University of Washington Global Assistance Program-Kenya, Box 20723-00202, Nairobi, Kenya.
| | - Betsy Sambai
- University of Washington Global Assistance Program-Kenya, Box 20723-00202, Nairobi, Kenya
| | - Aliza Monroe-Wise
- Department of Global Health, School of Public Health, University of Washington, UW Box #351620, Seattle, WA 98195, USA
| | - Natasha T Ludwig-Barron
- Department of Epidemiology, School of Public Health, University of Washington, UW Box # 351619, Seattle, WA 98195, USA; Department of Global Health, School of Public Health, University of Washington, UW Box #351620, Seattle, WA 98195, USA
| | - Brandon L Guthrie
- Department of Epidemiology, School of Public Health, University of Washington, UW Box # 351619, Seattle, WA 98195, USA; Department of Global Health, School of Public Health, University of Washington, UW Box #351620, Seattle, WA 98195, USA
| | - David Bukusi
- HTC and HIV Care, Kenyatta National Hospital, Box 20723-00202, Nairobi, Kenya
| | - Bhavna Chohan
- Department of Global Health, School of Public Health, University of Washington, UW Box #351620, Seattle, WA 98195, USA; Centre for Clinical Research, Kenya Medical Research Institute (KEMRI), Box 54840-00200, Nairobi, Kenya
| | - Paul Macharia
- National AIDS and STI Control Programme (NASCOP), Kenyatta Ministry of Health, Box 19362-00202, Nairobi, Kenya
| | - Matt Dunbar
- Department of Epidemiology, School of Public Health, University of Washington, UW Box # 351619, Seattle, WA 98195, USA
| | - Emily Juma
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Box 356423, Seattle, WA 98195, USA
| | - William Sinkele
- Support for Addictions Prevention and Treatment in Africa (SAPTA), Box 21761-00505, Nairobi, Kenya
| | - Esther Gitau
- Support for Addictions Prevention and Treatment in Africa (SAPTA), Box 21761-00505, Nairobi, Kenya
| | - Ashley S Tseng
- Department of Epidemiology, School of Public Health, University of Washington, UW Box # 351619, Seattle, WA 98195, USA; Department of Global Health, School of Public Health, University of Washington, UW Box #351620, Seattle, WA 98195, USA
| | - Rose Bosire
- Centre for Clinical Research, Kenya Medical Research Institute (KEMRI), Box 54840-00200, Nairobi, Kenya
| | - Sarah Masyuko
- Department of Global Health, School of Public Health, University of Washington, UW Box #351620, Seattle, WA 98195, USA; National AIDS and STI Control Programme (NASCOP), Kenyatta Ministry of Health, Box 19362-00202, Nairobi, Kenya
| | - Helgar Musyoki
- National AIDS and STI Control Programme (NASCOP), Kenyatta Ministry of Health, Box 19362-00202, Nairobi, Kenya
| | - Tecla M Temu
- Department of Global Health, School of Public Health, University of Washington, UW Box #351620, Seattle, WA 98195, USA
| | - Joshua Herbeck
- Department of Epidemiology, School of Public Health, University of Washington, UW Box # 351619, Seattle, WA 98195, USA; Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Box 356423, Seattle, WA 98195, USA
| | - Carey Farquhar
- Department of Epidemiology, School of Public Health, University of Washington, UW Box # 351619, Seattle, WA 98195, USA; Department of Global Health, School of Public Health, University of Washington, UW Box #351620, Seattle, WA 98195, USA; Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Box 356423, Seattle, WA 98195, USA
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Ngarachu EW, Kiburi SK, Owiti FR, Kangethe R. The prevalence and pattern of cannabis use among patients attending a methadone treatment clinic in Nairobi, Kenya. Subst Abuse Treat Prev Policy 2022; 17:12. [PMID: 35168646 PMCID: PMC8845270 DOI: 10.1186/s13011-022-00437-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Cannabis use during methadone treatment may negatively impact treatment outcomes. The aim of this study was to determine the prevalence and pattern of cannabis use among patients attending a methadone treatment clinic in Nairobi, Kenya. METHODS This was a retrospective study of 874 patients on methadone therapy at a methadone maintenance treatment clinic in Nairobi, Kenya from December 2014 to November 2018. Data on sociodemographic characteristics and drug use patterns based on urine drug screens was collected from patient files. Data was analyzed using Statistical Package for the Social Sciences (SPSS) for windows version 23.0. RESULTS Point prevalence of cannabis use was 85.8% (95% CI, 83.3 - 88.0) at baseline and 62.7% (95% CI, 59.5 - 65.8) during follow-up. A pattern of polysubstance use was observed where opioids, cannabis and benzodiazepines were the most commonly used drugs. The mean age of the patients was 35.3 (SD 9.0) years with the majority being male, unemployed (76%), (51.4%) had reached primary level of education, and (48.5%) were divorced or separated. University education was associated with reduced risk for cannabis use OR = 0.1 (95% CI, 0.02-0.8, p = 0.031). CONCLUSION Cannabis use is prevalent among patients attending a methadone treatment clinic in Kenya, suggesting need for targeted interventions to address the problem of cannabis use during methadone treatment.
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Affiliation(s)
| | | | | | - Rachel Kangethe
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
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8
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Kiburi SK, Mwangi J, Maina G. Exploring the experiences of clients receiving opioid use disorder treatment at a methadone clinic in Kenya: a qualitative study. Addict Sci Clin Pract 2022; 17:71. [PMID: 36510246 PMCID: PMC9742652 DOI: 10.1186/s13722-022-00352-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Assessing the experiences of individuals on methadone treatment is essential to help evaluate the treatment program's effectiveness. This study aimed to explore the experiences of patients receiving methadone treatment at a clinic in Nairobi, Kenya. METHOD This study employed an exploratory qualitative study design. Through purposive sampling, participants were enrolled from individuals attending a methadone clinic for at least 2 years. Semi-structured individual interviews were used to collect data on substance use and experience before methadone treatment and experiences after starting methadone treatment, including benefits and challenges. Interviews were transcribed, and NVIVO 12 software was used to code the data using the preidentified analytical framework. Thematic analyses were utilized to identify cross-cutting themes between these two data sets. Seventeen participants were enrolled. RESULTS Seventeen participants were enrolled comprising 70% males, with age range from 23 to 49 years and more than half had secondary education. The interview data analysis identified four themes, namely: (a) the impact of opioid use before starting treatment which included adverse effects on health, legal problems and family dysfunction; (b) learning about methadone treatment whereby the majority were referred from community linkage programs, family and friends; (c) experiences with care at the methadone treatment clinic which included benefits such as improved health, family reintegration and stigma reduction; and (d) barriers to optimal methadone treatment such as financial constraints. CONCLUSION The findings of this study show that clients started methadone treatment due to the devastating impact of opioid use disorder on their lives. Methadone treatment allowed them to regain their lives from the adverse effects of opioid use disorder. Additionally, challenges such as financial constraints while accessing treatment were reported. These findings can help inform policies to improve the impact of methadone treatment.
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Affiliation(s)
- Sarah Kanana Kiburi
- grid.411192.e0000 0004 1756 6158Department of Medicine, Aga Khan University Hospital, Nairobi, Kenya ,grid.16463.360000 0001 0723 4123Discipline of Psychiatry, University of KwaZulu Natal, Durban, South Africa
| | - Jackline Mwangi
- grid.9762.a0000 0000 8732 4964Department of Psychology, Kenyatta University, Nairobi, Kenya
| | - Geoffrey Maina
- grid.25152.310000 0001 2154 235XCollege of Nursing, Prince Albert Campus, University of Saskatchewan, Prince Albert, Canada
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9
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Ludwig-Barron NT, Guthrie BL, Mbogo L, Bukusi D, Sinkele W, Gitau E, Farquhar C, Monroe-Wise A. Barriers and facilitators of HIV and hepatitis C care among people who inject drugs in Nairobi, Kenya: a qualitative study with peer educators. Harm Reduct J 2021; 18:133. [PMID: 34922548 PMCID: PMC8684158 DOI: 10.1186/s12954-021-00580-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 12/01/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND In Kenya, people who inject drugs (PWID) are disproportionately affected by HIV and hepatitis C (HCV) epidemics, including HIV-HCV coinfections; however, few have assessed factors affecting their access to and engagement in care through the lens of community-embedded, peer educators. This qualitative study leverages the personal and professional experiences of peer educators to help identify HIV and HCV barriers and facilitators to care among PWID in Nairobi, including resource recommendations to improve service uptake. METHODS We recruited peer educators from two harm reduction facilities in Nairobi, Kenya, using random and purposive sampling techniques. Semi-structured interviews explored circumstances surrounding HIV and HCV service access, prevention education and resource recommendations. A thematic analysis was conducted using the Modified Social Ecological Model (MSEM) as an underlying framework, with illustrative quotes highlighting emergent themes. RESULTS Twenty peer educators participated, including six women, with 2-months to 6-years of harm reduction service. Barriers to HIV and HCV care were organized by (a) individual-level themes including the competing needs of addiction and misinterpreted symptoms; (b) social network-level themes including social isolation and drug dealer interactions; (c) community-level themes including transportation, mental and rural healthcare services, and limited HCV resources; and (d) policy-level themes including nonintegrated health services, clinical administration, and law enforcement. Stigma, an overarching barrier, was highlighted throughout the MSEM. Facilitators to HIV and HCV care were comprised of (a) individual-level themes including concurrent care, personal reflections, and religious beliefs; (b) social network-level themes including community recommendations, navigation services, family commitment, and employer support; (c) community-level themes including quality services, peer support, and outreach; and (d) policy-level themes including integrated health services and medicalized approaches within law enforcement. Participant resource recommendations include (i) additional medical, social and ancillary support services, (ii) national strategies to address stigma and violence and (iii) HCV prevention education. CONCLUSIONS Peer educators provided intimate knowledge of PWID barriers and facilitators to HIV and HCV care, described at each level of the MSEM, and should be given careful consideration when developing future initiatives. Recommendations emphasized policy and community-level interventions including educational campaigns and program suggestions to supplement existing HIV and HCV services.
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Affiliation(s)
- Natasha T Ludwig-Barron
- Department of Epidemiology, School of Public Health, University of Washington, 3980 15th Ave NE, Box # 351619, Seattle, WA, 98195, USA.
- Department of Global Health, School of Public Health and School of Medicine, University of Washington, 3980 15th Ave NE, Box #351620, Seattle, WA, 98195, USA.
| | - Brandon L Guthrie
- Department of Epidemiology, School of Public Health, University of Washington, 3980 15th Ave NE, Box # 351619, Seattle, WA, 98195, USA
- Department of Global Health, School of Public Health and School of Medicine, University of Washington, 3980 15th Ave NE, Box #351620, Seattle, WA, 98195, USA
| | - Loice Mbogo
- University of Washington Global Assistance Program-Kenya, Nairobi, Kenya
| | - David Bukusi
- VCT and HIV Prevention, Kenyatta National Hospital, Nairobi, Kenya
| | - William Sinkele
- Support for Addictions Prevention and Treatment in Africa (SAPTA), Nairobi, Kenya
| | - Esther Gitau
- Support for Addictions Prevention and Treatment in Africa (SAPTA), Nairobi, Kenya
| | - Carey Farquhar
- Department of Epidemiology, School of Public Health, University of Washington, 3980 15th Ave NE, Box # 351619, Seattle, WA, 98195, USA
- Department of Global Health, School of Public Health and School of Medicine, University of Washington, 3980 15th Ave NE, Box #351620, Seattle, WA, 98195, USA
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Box 356423, Seattle, WA, 98195, USA
| | - Aliza Monroe-Wise
- Department of Global Health, School of Public Health and School of Medicine, University of Washington, 3980 15th Ave NE, Box #351620, Seattle, WA, 98195, USA
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Box 356423, Seattle, WA, 98195, USA
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Ndimbii J, Guise A, Igonya EK, Owiti F, Strathdee S, Rhodes T. Qualitative Analysis of Community Support to Methadone Access in Kenya. Subst Use Misuse 2021; 56:1312-1319. [PMID: 34027819 PMCID: PMC10708729 DOI: 10.1080/10826084.2021.1922450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Methadone, as part of Medically Assisted Therapy (MAT) for treatment of opioid dependence and supporting HIV prevention and treatment, has been recently introduced in Kenya. Few low income settings have implemented methadone, so there is little evidence to guide ongoing scale-up across the region. We specifically consider the role of community level access barriers and support. OBJECTIVES To inform ongoing MAT implementation we implemented a qualitative study to understand access barriers and enablers at a community level. METHODS We conducted 30 semi-structured interviews with people who use drugs accessing MAT, supplemented by interviews with 2 stakeholders, linked to participant observation in a community drop in center within one urban area in Kenya. We used thematic analysis. RESULTS We developed five themes to express experiences of factors enabling and disabling MAT access and how community support can address these: 1) time, travel and economic hardship; 2) managing methadone and contingencies of life, 3) peer support among MAT clients as treatment ambassadors, 4) family relations, and 5)outreach project contributions. Crosscutting themes address managing socioeconomic constraints and gender inequities. CONCLUSIONS People who use drugs experience and manage socio-economic constraints and gender inequities in accessing MAT with the support of local communities. We discuss how these access barriers could be addressed through strengthening the participation of networks of people who use drugs in drug treatment and supporting community projects working with people who use drugs. We also explore potential for how socio-economic constraints could be managed within an integrated health and social care response.
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Affiliation(s)
| | - Andy Guise
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Emmy Kageha Igonya
- School of Medicine, University of Nairobi, Nairobi, Kenya
- Kenya & African Population and Health Research Center, Nairobi, Kenya
| | - Frederick Owiti
- School of Medicine, University of Nairobi, Nairobi, Kenya
- Kenya & African Population and Health Research Center, Nairobi, Kenya
| | - Steffanie Strathdee
- Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Tim Rhodes
- Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, London, UK
- University of New South Wales, Syndey, Australia
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