Convenience without disclosure: a formative research study of a proposed integrated methadone and antiretroviral therapy service delivery model in Dar es Salaam, Tanzania

Abstract

BackgroundThough timely initiation of antiretroviral therapy (ART) is a vital component of effective HIV prevention, care and treatment, people who inject drugs are less likely to receive ART than their non-drug using counterparts. In an effort to increase access to ART for people who inject drugs, we examined perceived benefits, challenges, and recommendations for implementing an integrated methadone and ART service delivery model at an opioid treatment program (OTP) clinic in Dar es Salaam, Tanzania.MethodsWe conducted in-depth interviews with 12 providers and 20 HIV-positive patients at the Muhimbili National Hospital OTP clinic in early 2015. We used thematic content analysis to examine patient and provider perspectives of an integrated model.ResultsRespondents perceived that offering on-site CD4 testing and HIV clinical management at the OTP clinic would improve the timeliness and efficiency of the ART eligibility process, make HIV clinical care more convenient, mitigate stigma and discrimination in HIV care and treatment settings, and improve patient monitoring and ART adherence. However, perceived challenges included overburdened OTP clinic staff and limited space at the clinic to accommodate additional services. Limited privacy at the OTP clinic and its contribution to fear among HIV-positive patients of being stigmatized by their peers at the clinic was a common theme expressed particularly by patients, and often corroborated by providers. Co-dispensing ART and methadone at the clinic’s pharmacy window was viewed as a potential deterrent for patients. Providers felt that an electronic health information system would help them better monitor patients’ progress, but that this system would need to be integrated into existing health information systems. To address these potential barriers to implementing an integrated model, respondents recommended increasing OTP provider and clinic capacity, offering flexible ART dispensing options, ensuring privacy with ART dispensing, and harmonizing any new electronic health information systems with existing systems.ConclusionsAn integrated methadone and ART service delivery model at the MNH OTP clinic could improve access to HIV care and treatment for OTP patients. However, specific implementation strategies must ensure that OTP providers are not overburdened and confidentiality of patients is maintained.

High-risk behaviors and their association with awareness of HIV status among participants of a large-scale prevention intervention in Athens, Greece

“…This finding is in agreement with previous studies, which found that HIV-infected PWID remain unaware of their serological status for a certain time [20,21,[32][33][34][35][36][37][38]. PWID might not seek HIV testing for a variety of reasons including stigma and discrimination [39][40][41][42][43][44], fear of finding out that they are infected, and their perception of being at low risk for HIV infection [38,45]. Moreover, reduced access to HIV testing services or affordable antiretroviral treatment due to insufficient and incorrect knowledge, long waiting time, and lack of family support [46] may be another barrier for PWID to learning their serological status.…”

Substance use and the HIV care continuum: important advances

“…Simeone et al [ 14 ] found 93% retention and HIV viral suppression among patients receiving integrated methadone and HIV primary care in an opioid treatment program—much higher than when HIV primary care was delivered off-site. Similarly, in-depth interviews with HIV providers and patients in Tanzania endorsed a preference for integrating HIV care in methadone treatment settings [ 15 ]. Additional implementation and comparative effectiveness studies are urgently needed to increase understanding of optimal approaches for integrating HIV and substance use treatment, both in clinical and non-clinical settings (e.g.…”

Qualitative Methods in Health Policy and Systems Research: A Framework for Study Planning

“…Formative evaluation occurs during program or policy development or modification and assesses things such as feasibility, appropriateness, and acceptability (Centers for Disease Control and Prevention, n.d.). As an example, Cooke et al (2017) examined patient and provider perspectives on the proposed implementation of an integrated HIV and methadone care model at an opioid treatment clinic. Process evaluation assesses whether a program or policy has been implemented as intended (Centers for Disease Control and Prevention, n.d.).…”