Is the promise of methadone Kenya's solution to managing HIV and addiction? A mixed-method mathematical modelling and qualitative study

BMJ Open
Tim RhodesPeter Vickerman

Abstract

Promoted globally as an evidence-based intervention in the prevention of HIV and treatment of heroin addiction among people who inject drugs (PWID), opioid substitution treatment (OST) can help control emerging HIV epidemics among PWID. With implementation in December 2014, Kenya is the third Sub-Saharan African country to have introduced OST. We combine dynamic mathematical modelling with qualitative sociological research to examine the 'promise of methadone' to Kenya. We model the HIV prevention impact of OST in Nairobi, Kenya, at different levels of intervention coverage. We draw on thematic analyses of 109 qualitative interviews with PWID, and 43 with stakeholders, to chart their narratives of expectation in relation to the promise of methadone. The modelled impact of OST shows relatively slight reductions in HIV incidence (5-10%) and prevalence (2-4%) over 5 years at coverage levels (around 10%) anticipated in the planned roll-out of OST. However, there is a higher impact with increased coverage, with 40% coverage producing a 20% reduction in HIV incidence, even when accounting for relatively high sexual transmissions. Qualitative findings emphasise a culture of 'rationed expectation' in relation to access to care and a 'p...Continue Reading

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Citations

Feb 4, 2016·The International Journal on Drug Policy·Jennifer L SyvertsenKarla D Wagner
Mar 22, 2016·The International Journal on Drug Policy·Tim Rhodes, Reychad Abdool
Mar 28, 2016·The International Journal on Drug Policy·Reychad Abdool
Oct 17, 2015·The International Journal on Drug Policy·Sasha MitalRichard Needle
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Jul 1, 2021·Journal of the International AIDS Society·Harry JinChris Beyrer
Nov 19, 2021·Epidemiologic Reviews·Magdalena CerdáKatherine M Keyes

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