Title

Early retention in a newly established Medically-Assisted Therapy Clinic in Kenya

Presenter

Doris Naitore

Authors

D. Naitore¹, A. Ngulu¹, K. Ndede¹, A. Howard², M. Mugambi³, H. Musyoki³, D. Onyango⁴, J. Otieno⁵, M. Hawken¹, R. Fayorsey², E. Abrams²

Institutions

¹Columbia University, Mailman School of Public Health, ICAP-Kenya, Nairobi, Kenya, ²ICAP at Columbia University, Program, New York, United States, ³National AIDS and STI Control Programme, Ministry of Health, Kenya, Key Populations, Nairobi, Kenya, ⁴Kisumu County, Health Department, Kisumu, Kenya, ⁵Jaramogi Oginga Odinga Teaching and Referal Hospital, Health Department, Kisumu, Kenya

Background: It is estimated there are 18,347 people who inject drugs (PWID) in Kenya, of whom approximately 1,000 live in the Nyanza region. The HIV prevalence amongst PWID is estimated to be 18%, which is three times that of the general population¹. This epidemic is driven by unsafe drug injecting practices and risky sexual behaviour. Medically-Assisted Therapy (MAT) is the supervised use of methadone replacement therapy for PWID to treat drug addiction, and is an important risk reduction strategy for HIV.
Methods: In March 2017, a MAT clinic was established at the Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) in the Nyanza region, Kenya. The clinic adopted a one stop shop model offering integrated HIV, TB and methadone treatment services. Clients are referred from a community drop-in center and screened for suitability for MAT. The MAT clinic offers HIV testing and counseling, Hepatitis B and C screening, STI screening, psychosocial support, ART for those who are HIV-positive, and TB screening and treatment. Staff were trained on national guidelines and clinic standard operating procedures.
Results: During a 10-month period from March to December 2017, 83 adults were screened for eligibility and 70 eligible patients were identified and initiated on MAT. Among the 70 who initiated MAT, 7 (10%) were female and 63 (90%) were male. Ten (14%) tested HIV-positive of which 100% were initiated on ART, and 7 (10%) were Hepatitis B surface antigen positive. One client had MDR-tuberculosis and was started on directly-observed therapy. Amongst the 53 clients who were receiving MAT services for 6 months or more, the 6-month retention rate for methadone treatment was 79% (42/53).
Conclusions: ICAP successfully established the first MAT clinic, with integrated HIV services at JOOTRH in western Kenya. The majority of clients served were men, and initial retention rates in methadone treatment have been good. Going forward strategies to further increase clinic referrals and uptake of MAT services should be explored.