Abstract
There are an estimated 50,000 people who inject drugs in Tanzania, with an HIV prevalence in this population of 42%. The Integrated Methadone and Anti-Retroviral Therapy (IMAT) strategy was developed to integrate HIV services into an opioid treatment program (OTP) in sub-Saharan Africa and increase anti-retroviral therapy (ART) initiation rates. In this paper, we evaluate the IMAT strategy using an implementation science framework to inform future care integration efforts in the region. IMAT centralized HIV services into an OTP clinic in Dar Es Salaam, Tanzania: HIV diagnosis, ART initiation, monitoring and follow up. A mixed-methods, concurrent design, was used for evaluation: quantitative programmatic data and semi-structured interviews with providers and clients addressed 4 out of 5 components of the RE-AIM framework: reach, effectiveness, adoption, implementation. Results showed high reach: 98% of HIV-positive clients received HIV services; effectiveness: 90-day ART initiation rate doubled, from 41% pre-IMAT to 87% post-IMAT (p < 0.001); proportion of HIV-positive eligible clients on ART increased from 71% pre-IMAT to 98% post-IMAT (p < 0.001). There was high adoption and implementation protocol fidelity. Qualitative results informed barriers and facilitators of RE-AIM components. In conclusion, we successfully integrated HIV care into an OTP clinic in sub-Saharan Africa with increased rates of ART initiation. The IMAT strategy represents an effective care integration model to improve HIV care delivery for OTP clients.
Highlights
The prevention, treatment and management of HIV in key populations have been recognized as a global priority if we are to reach the UNAIDS 2030 ‘End of AIDS’ target [1,2]
At the end of the study period, 96% (130/136) of HIV-positive clients were engaged in Integrated Methadone and Anti-Retroviral Therapy (IMAT)
Semi-structured interviews explained that high reach was in part attributable to clients recognizing the benefit of integrated services
Summary
The prevention, treatment and management of HIV in key populations have been recognized as a global priority if we are to reach the UNAIDS 2030 ‘End of AIDS’ target [1,2]. The evidence for using treatment as prevention for key populations is strong—the World Health Organization (WHO). People who inject drugs account for 10% of HIV infections world-wide [6,7]. People who inject drugs (PWID) are less likely to receive ART than their non-drug using counterparts, with only 4% of PWID receiving ART (compared to 46% world-wide coverage) [8]. The prompt treatment of PWID is imperative to curb the spread of HIV and reduce HIV-related mortality [9,10]. Res. Public Health 2019, 16, 728; doi:10.3390/ijerph16050728 www.mdpi.com/journal/ijerph
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