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Addressing the Micro- and Macro-Environmental Vulnerabilities to HIV of People Who Inject Drugs in Tanzania: A Case Study of the Muhimbili Medication-Assisted Treatment Clinic

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Part of the Social Aspects of HIV book series (SHIV,volume 4)

Abstract

It is estimated that there are 30,000 people who inject drugs in mainland Tanzania, with an approximate HIV prevalence of 35% in this key population. Drug use is criminalized in Tanzania and treatment options are limited. However, in February 2011, a cutting-edge medication-assisted treatment (MAT) clinic for opioid addiction offering methadone maintenance treatment was established at Muhimbili National Hospital in Dar es Salaam. The clinic, which began offering drug treatment and harm reduction services, now offers a multi-faceted array of health and social services to address the myriad of psychosocial and structural factors impacting the well-being of people who use drugs in that setting. These services include HIV counseling and testing and linkages to on-site HIV care and treatment services, screening and treatment for tuberculosis and other medical and mental disorders, and access to on-site social workers and affiliated occupational therapists. Social workers at the Muhimbili MAT clinic link MAT clients to community-based organizations that provide individual counseling, 12-step programs, family group therapy, and income-generating skills training, among other services for people who use drugs. This chapter uses a risk environment framework to describe the micro- and macro-environmental factors that place people who inject drugs at increased risk of HIV and documents innovative initiatives and partnerships that have been formed to address these factors through an in-depth case study of the Muhimbili National Hospital MAT clinic.

Keywords

  • HIV
  • People who use drugs
  • People who inject drugs
  • Substance use
  • Methadone maintenance treatment
  • Tanzania
  • Africa

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Fig. 3.1

Notes

  1. 1.

    In response to a very low number of female clients enrolling into methadone treatment, another MAT clinic at Mwananyamala Regional Hospital, established in September 2012, piloted an approach, beginning in February 2013, allowing women dependent on heroin to enroll directly at the clinic rather than having to first attend the series of sessions at the CBOs. In addition, existing female clients were encouraged to recruit their peers and one day of the week was set aside for enrolling female clients only. This approach improved women’s enrollment into the methadone clinic at Mwananyamala, thereby increasing the proportion of female MAT clients.

  2. 2.

    The first-line tuberculosis treatment regimen in Tanzania includes Isoniazid, Rifampicin, Pyrazinamide, Ethambutol, and Streptomycin formulated in fixed drug combinations (United Republic of Tanzania 2013). The recommended standardized multi-drug resistant tuberculosis treatment regimen includes Amikacin, Ofloxacin/Levofloxacin, Pyrazinamide, Ethionamide, Cycloserine, and Ethambutol (if no resistance to Ethambutol is documented) (United Republic of Tanzania 2012).

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Mbwambo, J., Saleem, H.T., Kaduri, P., Lambdin, B.H., McCurdy, S.A. (2018). Addressing the Micro- and Macro-Environmental Vulnerabilities to HIV of People Who Inject Drugs in Tanzania: A Case Study of the Muhimbili Medication-Assisted Treatment Clinic. In: Kerrigan, D., Barrington, C. (eds) Structural Dynamics of HIV. Social Aspects of HIV, vol 4. Springer, Cham. https://doi.org/10.1007/978-3-319-63522-4_3

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