Abstract:

Background: The dramatic rise in intravenous drug use particularly heroin has been associated with elevated HIV transmission risk in sub-Saharan Africa. Medically assisted therapy (MAT) is crucial for HIV prevention in people who inject opioids including heroin. The objective of the present study was to determine the uptake of MAT among people who inject heroin (PWIH) and associated factors to assist in informing policy.

Methods: A cross-sectional study was conducted in Mathare low income settlement in the city of Nairobi, Kenya. Injecting heroin users were recruited in the study during the routine follow-up at a drop-in Centre. Information about factors associated with uptake of MAT among Injecting heroin users was obtained using an interviewer-administered questionnaire.

Results: Of the 110 people PWIH enrolled in study, 73 respondents had ever enrolled for MAT (uptake: 66% (95% confidence interval (CI) 57%, 75%)). Socio-demographic factors associated with uptake of MAT included age, gender, marital status, education level and employment status (p<0.05). Association between uptake of MAT and characteristics/practices related to the use of heroin returned four significant variables (p<0.05): length of time the participant had injected heroin, daily frequency of heroin injection, prior attempt to quit heroin injection and polydrug use. Key health systems factors associated with uptake of MAT included personal views about eligibility criteria for PWID and hours of operation of the MAT clinic.

Conclusion: Our study identified modifiable factors associated with MAT in low income urban settlers which if prioritized can accelerate the already high uptake found in this study.

Keywords: Heroin, Therapy, Opioid, Human Immunodeficiency Virus, Medically Assisted Therapy, People Who inject Drugs

References:

[1].Alavi, M., Grebely, J., Micallef, M., Dunlop, A. J., Balcomb, A. C., Day, C. A., ... & Enhancing Treatment for Hepatitis C in Opioid Substitution Settings (ETHOS) Study Group. (2013). Assessment and treatment of hepatitis C virus infection among people who inject drugs in the opioid substitution setting: ETHOS study. Clinical Infectious Diseases, 57(suppl_2), S62-S69.

[2].Ayon, S., Ndimbii, J., Jeneby, F., Abdulrahman, T., Mlewa, O., Wang, B., ... & Mburu, G. (2018). Barriers and facilitators of access to HIV, harm reduction and sexual and reproductive health services by women who inject drugs: role of community-based outreach and drop-in centers. AIDS care, 30(4), 480-487.

[3].Beckerleg, S., Telfer, M., & Sadiq, A. (2006). A rapid assessment of heroin use in Mombasa, Kenya. Substance use & misuse, 41(6-7), 1029-1044.

[4].Beyrer, C., Baral, S., Kerrigan, D., El-Bassel, N., Bekker, L. G., & Celentano, D. D. (2011). Expanding the space: inclusion of most-at-risk populations in HIV prevention, treatment, and care services. Journal of acquired immune deficiency syndromes (1999), 57(Suppl 2), S96.

[5].Booth, R. E., Crowley, T. J., & Zhang, Y. (1996). Substance abuse treatment entry, retention and effectiveness: out-of-treatment opiate injection drug users. Drug and alcohol dependence, 42(1), 11-20.

[6].Centers for disease control and prevention (CDC Kenya). Kenya Annual Report. Nairobi. CDC. 2015.

[7].Costigan, G., N. Crofts, and G. Reid. "Manual for reducing drug related harm in Asia. Revised and updated." (2003).

[8].Corburn, J. (2013). Healthy city planning: from neighbourhood to national health equity. Routledge.

[9].Coviello, D. M., Zanis, D. A., Wesnoski, S. A., & Alterman, A. I. (2006). The effectiveness of outreach case management in re-enrolling discharged methadone patients. Drug and alcohol dependence, 85(1), 56-65.

[10]. Deveau, C., Levine, B., & Beckerleg, S. (2006). Heroin use in Kenya and findings from a community based outreach programme to reduce the spread of HIV/AIDS. African Journal of Drug & Alcohol Studies, 5(2), 95-107.

[11]. Digiusto, E., & Treloar, C. (2007). Equity of access to treatment, and barriers to treatment for illicit drug use in Australia. Addiction, 102(6), 958-969.

[12]. Gelmon, L. (2009). Kenya HIV prevention response and modes of transmission analysis. National AIDS Control Council.

[13]. Goldstein, R. Z., & Volkow, N. D. (2002). Drug addiction and its underlying neurobiological basis: neuroimaging evidence for the involvement of the frontal cortex. American Journal of Psychiatry, 159(10), 1642-1652.

[14]. Guise, A., Rhodes, T., Ndimbii, J., Ayon, S., & Nnaji, O. (2016). Access to HIV treatment and care for people who inject drugs in Kenya: a short report. AIDS care, 28(12), 1595-1599.

[15]. Hyde Lily (2016). State of harm reduction in Kenya, key information about drug use -community action against harm reduction CAHR http://www.cahrproject.org/wp-content/uploads/2016/04/kenya-report

[16]. Lawrinson, P., Ali, R., Buavirat, A., Chiamwongpaet, S., Dvoryak, S., Habrat, B., ... & Newcombe, D. (2008). Key findings from the WHO collaborative study on substitution therapy for opioid dependence and HIV/AIDS. Addiction, 103(9), 1484-1492.

[17]. Mathers, B. M., Degenhardt, L., Ali, H., Wiessing, L., Hickman, M., Mattick, R. P., ... & Strathdee, S. A. (2010). HIV prevention, treatment, and care services for people who inject drugs: a systematic review of global, regional, and national coverage. The Lancet, 375(9719), 1014-1028.

[18]. Ministry of Health (2013). Kenya National Guidelines for: Standard Operating Procedures for Medically Assisted Therapy for People Who Use Drugs. Nairobi.

[19]. Ministry of Health. Kenya National Guidelines for: Standard Operating Procedures for Medically Assisted Therapy for People Who Use Drugs. Nairobi. 2013.

[20]. Mlunde, L. B., Sunguya, B. F., Mbwambo, J. K. K., Ubuguyu, O. S., Shibanuma, A., Yasuoka, J., & Jimba, M. (2016). Correlates of health care seeking behaviour among people who inject drugs in Dar es Salaam, Tanzania. International Journal of Drug Policy, 30, 66-73.

[21]. Nambiar, D., Stoové, M., & Dietze, P. (2014). A cross-sectional study describing factors associated with utilisation of GP services by a cohort of people who inject drugs. BMC health services research, 14(1), 308.

[22]. National Institute on Drug Abuse (NIDA). Heroin. NIDA. 2014.

[23]. National Institute on Drug Abuse (2017). Heroin

[24]. National Institutes of Health. (2007). NIH Consensus Statement: Effective Medical Treatment of Opiate Addiction.

[25]. Obeng-Odoom, F. (2013). The State of African Cities 2010: Governance, inequality and urban land markets. Cities, 31, 425-429.

[26]. Oguya, F. O. (2014). Assessment of Risk Behaviour and HIV Prevalence among People Who Inject Drugs in Nairobi County, Kenya (Doctoral dissertation, Kenyatta University).

[27]. Pinkham, S., Stoicescu, C., & Myers, B. (2012). Developing effective health interventions for women who inject drugs: key areas and recommendations for program development and policy. Advances in Preventive Medicine, 2012.

[28]. Petersen, Z., Myers, B., Van Hout, M. C., Plüddemann, A., & Parry, C. (2013). Availability of HIV prevention and treatment services for people who inject drugs: findings from 21 countries. Harm reduction journal, 10(1), 13.

[29]. Roberts, J., Annett, H., & Hickman, M. (2010). A systematic review of interventions to increase the uptake of opiate substitution therapy in injecting drug users. Journal of Public Health, 33(3), 378-384.

[30]. Robles, R. R., Reyes, J. C., Colón, H. M., Sahai, H., Marrero, C. A., Matos, T. D., ... & Shepard, E. W. (2004). Effects of combined counseling and case management to reduce HIV risk behaviors among Hispanic drug injectors in Puerto Rico: a randomized controlled study. Journal of Substance Abuse Treatment, 27(2), 145-152.

[31]. Strathdee, S. A., Ricketts, E. P., Huettner, S., Cornelius, L., Bishai, D., Havens, J. R., ... & Latkin, C. A. (2006). Facilitating entry into drug treatment among injection drug users referred from a needle exchange program: Results from a community-based behavioral intervention trial. Drug and alcohol dependence, 83(3), 225-232.

[32]. Todadze, K., & Lezhava, G. (2008). Implementation of drug substitution therapy in Georgia. Central European journal of public health, 16(3).

[33]. Tun, W., Sheehy, M., Broz, D., Okal, J., Muraguri, N., Raymond, H. F., ... & Geibel, S. (2015). HIV and STI prevalence and injection behaviors among people who inject drugs in Nairobi: results from a 2011 bio-behavioral study using respondent-driven sampling. AIDS and Behavior, 19(1), 24-35.

[34]. United Nations Office on Drugs, & Crime. (2010). World drug report 2010. United Nations Publications.

[35]. Vijay, A., Bazazi, A. R., Yee, I., Kamarulzaman, A., & Altice, F. L. (2015). Treatment readiness, attitudes toward, and experiences with methadone maintenance therapy among people who inject drugs in Malaysia. Journal of substance abuse treatment, 54, 29-36.

[36]. WHO, U. (2008). Principles of Drug Dependence Treatment: Discussion Paper. United Nations publication.

[37]. WHO, U. (2009). UNAIDS. WHO, UNODC, UNAIDS technical guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users. World Health Organisation.