IntroductionCurrent estimates suggest an HIV prevalence of 42% among people who inject drugs (PWIDs) in Dar es Salaam, while HIV prevalence is estimated to be 8.8% among the general population in the city. To address the HIV epidemic in this population, the government of Tanzania began establishing HIV prevention, treatment and care services including outreach and medication assisted treatment (MAT) for PWIDs in 2010. We assessed gender inequities in utilization of outreach and MAT services and evaluated differences in HIV risk behaviors between female and male PWIDs.Materials and MethodsRoutine outreach data between December 2010 to mid-August 2012 and baseline data on clients enrolling in methadone from February 2011 to August 2012 were utilized. Binomial regression was used to estimate adjusted relative risk estimates comparing females to males.ResultsFrom December 2010 to August 2012, 8,578 contacts were made to drug users; among them 1,898 were injectors. A total of 453 injectors were eligible and referred to MAT, of which, 443 enrolled in treatment. However, regarding total outreach contacts, outreach to PWID, referral to MAT and enrollment in MAT, 8% or less of drug users accessing services were women. In contrast, weighted estimations from surveys suggest that 34% of PWIDs are female, and this approximation is similar to recent population size estimations. Overall, 43% of traditional outreach workers conducting outreach with drug users were female. Though reporting higher levels of condom usage, female PWID were more likely to report multiple sex partners, anal sex, commercial sex work and struggle under a higher burden of addiction, mental disorders and abuse.ConclusionsServices have not been mobilized adequately to address the clear needs of females who inject drugs. A clear and urgent need exists for women-centered strategies that effectively engage female PWID into HIV prevention services.

Patient retention in methadone maintenance is comparable to estimates from programs in North America, Europe, and Asia. Future implementation strategies should focus on higher doses and flexible dosing strategies to optimize program retention and strengthened efforts for clients at higher risk of attrition.

Background The first methadone maintenance treatment (MMT) clinic in Tanzania was launched in February 2011 to address an emerging HIV epidemic among people who inject drugs (PWID). We conducted a retrospective cohort study to understand factors associated with linkage to HIV care and explore how a MMT clinic can serve as a platform for integrated HIV care and treatment. Methods This study utilized routine programmatic and clinical data on clients enrolled in methadone at Muhimbili National Hospital from February 2011 to January 2013. Multivariable proportional hazards regression model were used to examine time to initial CD4 count. Results Final analyses included 148 HIV-positive clients, contributing 31.7 person-years. At 30, 60 and 90 days, the probability of CD4 screening was 40% (95% CI: 32–48%), 55% (95% CI: 47%–63%) and 63% (95% CI: 55%–71%), respectively. Clients receiving high methadone doses (≥85mg/day) [aHR:1.68, 95% CI:(1.03, 2.74)] had higher likelihood of CD4 screening than those receiving low doses (<85 mg/day). Clients with primary education or lower [aHR:1.62, 95% CI:(1.05, 2.51)] and self-reported poor health [aHR:1.96, 95% CI:(1.09, 3.51)] were also more likely to obtain CD4 counts. Clients with criminal arrest history [aHR: 0.56, 95% CI: (0.37, 0.85)] were less likely to be linked to care. Among 17 ART-eligible clients (CD4≤200), 12 (71%) initiated treatment, of which 7 (41%) initiated within 90 days. Conclusions Levels of CD4 screening and ART initiation were similar to Sub-Saharan programs caring primarily for non-PWID. Adequate methadone dosing is important in retaining clients to maximize HIV treatment benefits and allow for successful linkage to services.