From a staff-led to a community-based drop-in center for people who use drugs – Lessons learnt in Temeke, Tanzania

Galawa Musa GALAWA, Halfani Farjala MWASHA, Ally Ramadhani MTANDIKA, Kevin Joseph NYERERE, Remmy Wilson SHOO

There are 30,000 people who inject drugs (PWID) in Tanzania with an HIV prevalence of 36% as per the National AIDS Control Program. In 2010 Médecins du Monde (MdM) started implementing comprehensive Harm Reduction (HR) in Tanzania, based in Temeke District with the aim to reduce HIV and other blood-borne viruses transmission among People Who Use Drugs (PWUD) and particularly PWID.

MdM has been implementing through two approaches: outreach and Drop-In Center (DIC). At the beginning, these activities were implemented by staff members who were not part of the PWUD community, with occasional support from people from the communities.

These Peer Educators (PE) shared their knowledge about PWUD practices and habits with other staff members and became an essential part of the team. MdM training & resource center supported the PE through literacy, HR and communication trainings, and they were provided on-the-job mentoring. The PE progressively took on some of the DIC activities such as registration of the new beneficiaries, data collection, maintaining the DIC, provision of information education & communication material, and referral to other health facilities.
The PE also started to take part in the decision-making process and proposed to improve and shorten the methadone education from 5 to 2 weeks to prevent drop-offs. They also set up new services like a self-support group for PWUD on methadone.

Today all the services of the DIC except medical and psychosocial consultations are provided by PE who come from the same background as the PWUD using the services. The presence of PE at all the levels of the DIC makes the communication with the PWUD smoother and more impactful. As the PE tailored the services to the actual needs of the PWUD, the quality of the services has improved. It also strengthens community ownership of the HR program.