addiction treatment methadone perspectives from a qualitative study

Supporting community action on HIV & AIDs and TB

Addiction Treatment: Methadone

perspectives from a qualitative study

James NdimbiiKANCOAccess2Care Study


Harm reduction in Kenya-introduction and current situation

Access to care study-background The risk environment approach Study Methodology Findings Acknowledgements

Outline


CAHR – harm reduction in Kenya

WHO Comprehensive Package Harm Reduction’ refers to policies, programmes and practices

that aim primarily to reduce the adverse health, social and economic consequences of the use of legal and illegal psychoactive drugs without necessarily reducing drug consumption.

NSP pilot program since December 2012

Comprehensive HIV prevention, treatment and care

OST/MAT Promoted globally as evidence based in relation to HIV prevention and

management of opiate addiction Rolled out December 2014


Context Est 18,500 PWID, est HIV prevalence 18.3% (44.5% for

women) Introduction of harm reduction services – needle and

syringe exchange Study aim – understand the risk environment

Understand impact of new services, and experience of PWID, to support on-going development of harm reduction services

Understand the contextual environment in relation to implementation

Background


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o ‘risk environments’ shape HIV prevention capacity and response

o ‘risk environments’ are made up through a complex interplay of cross-cutting factors and levels

o a ‘risk environment’ approach considers HIV as the outcome of individual-environment interaction

o a ‘risk and enabling environment’ approach moves beyond individual actions alone to consider social and structural interventions

Risk environmentsRisk environments


A2C study: methodology

Three sites – Malindi (Omari Project), Ukunda (Teenswatch), Nairobi (NOSET)

Qualitative: In-depth interviews with PWID, observation, stakeholder interviews

Longitudinal: 3 waves of data collection

Baseline 6 mths 12 mths

NAIROBI PWID: N=30 PWID: N=12 PWID: N=12

Stakeholders: N=7MALINDI PWID: N=50 PWID: N=16 PWID: N=16

Stakeholders: N=7

UKUNDA PWID: N=30 PWID: N = 5 PWID:N = 5

Stakeholders: N=7


Findings

NSP (Needle and Syringe Program)- before and since the implementation

Addiction treatment – limited Access to HIV care for PWID- Available, competing

against everyday demands of addiction Changes in the HIV and harm reduction policy

environment


As at 2014Poverty of drug treatment opportunityAccess workFee based rehab, detoxificationPoor treatment outcomesRehab as respiteThe promise of methadone

Addiction Treatment


The promise of methadone

The promise of withdrawal managemento They are saying that if someone takes it, he will stop smoking stuff or injecting… If

I take it, I will stop using drugs. If I cannot take it, then I’ll continue injecting.o I have heard that if you take it, you will not have pain. There is no way that you

will have desire for the drugs, now if you take this thing you will be OK.

o If you want to stop stuff, it will not be hard, as you will not suffer when you decide to stop.

o If I don’t feel withdrawals, isn’t that an easy way of staying away from addiction?


The promise of methadoneThe promise of rehabilitation and social inclusiono Many people don’t want to go to rehab. It is like time wasting. Six months you are

locked somewhere and after that you come out, you don’t have the skills, you cannot be employed, you are just idle. That will take you back to using drugs. But with methadone, if you are working you don’t have to go to the rehab, you can be in control, you can substitute the heroin with the methadone.

o The idea is as soon as people start using this new medicine from outside, these people (drug users) are going to be OK. They perceive that people will stay away from drugs, and there won’t be people using drugs, so there won’t be any problems related to drug use. We give methadone to the people, and the problem is over... They don’t need to take drugs, they don’t need to inject themselves, they don’t need to steal, they can go to work. That’s what we want! [stakeholder]


Ambiguity and uncertaintyWaiting and the rationing of expectationo We are waiting for that medicine to reduce using. We have been waiting for a while, but

we have not yet got it.o We still don’t know. We are waiting to hear from them [MoH] (Jan, 14) / We still haven’t

heard when the methadone is going to start (June,14).o We don’t even talk about methadone anymore. Every time we ask, we are told “maybe

next month”… And now for two years they have been telling us that it is “soon”. It has come to a point where we don’t believe there is going to be any methadone programme… People were eager at first. They thought ‘this is our chance to get out of this shit’. But because nothing has happened, people no longer think about it. When you ask about it, they think ‘Ah, you are wasting you time telling us about methadone’, because we don’t believe it will happen.

Projected impact of opioid substitution treatment (OST) on HIV prevalence and incidence at varied coverage levels.

Tim Rhodes et al. BMJ Open 2015;5:e007198

©2015 by British Medical Journal Publishing Group


NOSET: Calleb Angira, Abbas Said Abdulaziz, Hussein Rama Owino, NoSET

The Omari Project: Mohammed Shosi, Athman Mohammed Famau, Alphonce Maina Thuo, Ali Omar Haji.

Teenswatch: Cosmas Maina, Athuman Bundo, Tabitha Waithera.

KANCO Sylvia Ayon, James Ndimbii

London School of Hygiene and Tropical Medicine Tim Rhodes Andy Guise

With NASCOP and NACC

The Access to Care Study

addiction treatment methadone perspectives from a qualitative study

Healthcare