The first publicly funded program to provide methadone maintenance therapy to people who inject opiate drugs on the mainland of sub-Saharan Africa retained clients at rates comparable to wealthier countries and, in the process, yielded information that could increase the success of other such programs, a study has shown. The program, and the study to examine its outcomes, are described in a recently released article and commentary in Clinical Infectious Diseases.
The article spells out the urgent need for an effort to reach, support and lower the risks facing people who inject drugs in Tanzania, a country already grappling with a growing epidemic affecting the general population in the 1990s when injecting drug use began to spread. Now, Tanzania is home to about 50,000 people who inject drugs. Needle sharing as well as condomless sex with multiple partners are widespread among people who use injecting drugs, and HIV prevalence rates reflect the results: 71 percent of women and girls who inject drugs are estimated to be living with HIV and estimates of HIV prevalence among men and women who inject drugs across the nation’s capital, Dar es Salaam, range from 42 percent to 50 percent in a city where overall HIV prevalence is estimated at just under 7 percent.
Against that backdrop, the Tanzanian government, with donor support (including from the U.S. President’s Emergency Plan for AIDS Relief and the U.S. Centers for Disease Control and Prevention) opened the country’s first methadone maintenance clinic in 2011. Located in a national hospital in the capital city, over the next two years it served 629 people who were dependent on, and tested positive for injected opiate drugs. About three-quarters of them, 469 people tested to discover if they had HIV, and 185 of them did. The program offered daily methadone doses, onsite only. HIV counseling and testing, tuberculosis testing, and psychological and social support services also were offered onsite.
At the end of two years, more than half of the patients — 354 — remained in the program. Of the 264 who were no longer in the program, 2 percent had been discharged for violating the terms of the program, 3 percent had died, and 95 percent had dropped out. Dropping out was more common among young participants than older ones, and among men than women. The percentage of drop outs reflected percentages in programs in other countries.
Researchers also found people receiving higher doses of methadone were less likely to drop out, and note that is an important piece of information for other programs. In addition, the commentary accompanying the article on the study notes that Tanzania set an example for a working program with a safe environment — in which participants did not have to fear arrest as they arrived at, or left the clinic, as occurs in some countries.
That example and other information gleaned from the data and from future research will be important, the authors note. Injection drug use has been noted in 20 African countries, including Kenya, Nigeria, and South Africa.