Uptake of Medically Assisted Therapy among People Who Inject Heroin in Mathare Low Income Settlements, Nairobi County

Abstract

Heroin is an illegal, highly addictive opioid that is injected, snorted, or smoked. Use of injected heroin is a public health concern because it promotes spread of HIV and viral hepatitis. The national prevalence of HIV and HCV among People who inject drugs in Kenya has been reported to be 18.9% and 30% respectively. Mathare low income settlements has the biggest heroin injecting den in Nairobi. Medically Assisted Therapy is the use of Opioid agonist prescription medications for the management of persons that are dependent on opioids and have used opioids for an extended period. The first Medically Assisted Therapy program in Kenya was started in December 2014 in Nairobi and less than 1% of people who inject heroin were accessed this therapy. This demonstrates poor uptake. The broad objective of this study was to determine the uptake and factors associated with uptake of Medically Assisted Therapy among People who inject heroin in Mathare low income settlements. The study employed a cross-sectional study design and quantitative data was collected. The study was carried out in Support for Addiction Prevention Treatment Drop in Center where harm reduction services are provided to People who inject drugs in Mathare low income settlements. The study population was People who inject heroin who were recruited in a consecutive manner until the desired sample size of 110 was attained. An interviewer administered questionnaire was the main tool used in data collection. Bivariate analysis was conducted using chi square ((χ2) test or Fisher exact test where appropriate. Binary logistic regression was used to evaluate the factors which were predictive of uptake of Medically Assisted Therapy while controlling for potential confounders. All participating respondent signed an informed consent before participating in the study. Of the 110 people PWIH enrolled in study, 73 respondents had ever enrolled for Medically Assisted Therapy (uptake: 66% (95% confidence interval (CI) 57%, 75%)). Socio-demographic factors associated with uptake of Medically Assisted Therapy included age, gender, marital status, education level and employment status (p<0.05). Association between uptake of Medically Assisted Therapy and characteristics/practices related to the use of heroin returned four significant variables (p<0.05): length of time the participant had injected heroin, daily frequency of heroin injection, prior attempt to quit heroin injection and polydrug use. Key health systems factors associated with uptake of Medically Assisted Therapy Medically Assisted Therapy included personal views about eligibility criteria for People who inject heroin and hours of operation of the Medically Assisted Therapy clinic. The study identified modifiable factors associated with Medically Assisted Therapy in low income urban settlers which if prioritized can accelerate the already high uptake found in this study. In order to enhance the uptake of Medically Assisted Therapy and other harm reduction services, the study recommends exploring approaches that will address the disparities observed with respect to the sex and literacy levels of the People who inject heroin. The Ministry of health should review the Medically assisted Therapy policy guideline and develop strategies to promote and enhance satisfaction of People who inject heroin seeking care in the health facilities, particularly, ensuring that the eligibility criteria and the hours of operation in the Medically Assisted Therapy clinic are convenient to the targeted clientele.