Enhancing access through DOTs for HIV/TB PWUDs in Medically Assisted Therapy(MAT) clinic, Malindi Kenya

Samuel Tunje, Saade Abdallah, Sanga Deche, Menza Benjamin Kirimo

Institution
1.MSCH
2.UNODC
Issue:
Poor adherence to ARVs and anti-TBs treatment among people who use drugs (PWUD) is an emerging issue as Kenya scales up access to comprehensive harm reduction services. This may be attributed to stigma, homelessness and lack of family support. Sub-optimal adherence increases risk of new HIV infections, drug resistant strains, thereby compromising Kenya’s attainment of 90-90-90 targets by 2030.
Settings:
There are an estimated 18,327 people who inject drugs in Kenya, 11% of them residing in Malindi. HIV prevalence for PWID in Malindi is 22%. About 30% of PLHIV in Kenya have TB co-infection.
Project:
Kilifi County Government started MAT at Malindi Hospital in February, 2015. The Omari Project, a local NGO, mobilizes and refers eligible PWUD for enrollment. All MAT clients make daily visits for methadone intake through Daily Observed Therapy (DOTs). Clients with HIV and TB co-morbidities can access ARVs and anti-TBs drugs if they wish.
Outcome:
By September 2016, 487 clients enrolled, females comprising 8% (40); 11% (57) HIV positive, 9.4% (42) males versus 37.5% (15) females; 4.0% (18) had TB (all males), 1.6% (7) had HIV/TB; 1 had Rifampicin Resistance (RR). Of 57 HIV positive clients, 11.9% (5) males and 6.6% (1) female on ART via DOTs, while others picked ARVs at Comprehensive HIV Care Clinic (CCC). 27.3% (3) of 11 HIV Negative TB clients cured versus 57% (4) of HIV/TB co-infected clients. 38.8% (7) of TB cases had relapsed, 27.8% (5) were lost to follow up, 5 newly diagnosed and 1 initiated alternative anti-TB regimen for RR at Omari Project.
Despite successful MAT roll out in Malindi, barriers hamper MAT/HIV/ TB treatment integration, such as: self-stigma, inadequate privacy at MAT dispensing window, heavy workload for pharmacists, and client preferences. Infrastructural improvements, additional staffing and client education were warranted for best outcome.