"Can't you initiate me here?"

Challenges to timely initiation on antiretroviral therapy among methadone clients in Dar es Salaam, Tanzania

Haneefa Saleem, Dorothy Mushi, Saria Hassan, R. Douglas Bruce, Alexis Cooke, Jessie Mbwambo, Barrot H. Lambdin

Research output: Contribution to journalArticle

Abstract

Background: Despite dramatic improvement in antiretroviral therapy (ART) access globally, people living with HIV who inject drugs continue to face barriers that limit their access to treatment. This paper explores barriers and facilitators to ART initiation among clients attending a methadone clinic in Dar es Salaam, Tanzania. Methods: We interviewed 12 providers and 20 clients living with HIV at the Muhimbili National Hospital methadone clinic between January and February 2015. We purposively sampled clients based on sex and ART status and providers based on job function. To analyze interview transcripts, we adopted a content analysis approach. Results: Participants identified several factors that hindered timely ART initiation for clients at the methadone clinic. These included delays in CD4 testing and receiving CD4 test results; off-site HIV clinics; stigma operating at the individual, social and institutional levels; insufficient knowledge of the benefits of early ART initiation among clients; treatment breakdown at the clinic level possibly due to limited staff; and initiating ART only once one feels physically ill. Participants perceived social support as a buffer against stigma and facilitator of HIV treatment. Some clients also reported that persistent monitoring and follow-up on their HIV care and treatment by methadone clinic providers led them to initiate ART. Conclusion: Health system factors, stigma and limited social support pose challenges for methadone clients living with HIV to initiate ART. Our findings suggest that on-site point-of-care CD4 testing, a peer support system, and trained HIV treatment specialists who are able to counsel HIV-positive clients and initiate them on ART at the methadone clinic could help reduce barriers to timely ART initiation for methadone clients.

Original languageEnglish (US)
Pages (from-to)59-65
Number of pages7
JournalInternational Journal of Drug Policy
Volume30
DOIs
StatePublished - Apr 1 2016
Externally publishedYes

Fingerprint

Tanzania
Methadone
HIV
Therapeutics
Social Support
Secondary Prevention

Keywords

  • Antiretroviral therapy
  • Integrated services
  • Methadone
  • Qualitative
  • Tanzania

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Health Policy

Cite this

"Can't you initiate me here?" : Challenges to timely initiation on antiretroviral therapy among methadone clients in Dar es Salaam, Tanzania. / Saleem, Haneefa; Mushi, Dorothy; Hassan, Saria; Douglas Bruce, R.; Cooke, Alexis; Mbwambo, Jessie; Lambdin, Barrot H.

In: International Journal of Drug Policy, Vol. 30, 01.04.2016, p. 59-65.

Research output: Contribution to journalArticle

Saleem, Haneefa ; Mushi, Dorothy ; Hassan, Saria ; Douglas Bruce, R. ; Cooke, Alexis ; Mbwambo, Jessie ; Lambdin, Barrot H. / "Can't you initiate me here?" : Challenges to timely initiation on antiretroviral therapy among methadone clients in Dar es Salaam, Tanzania. In: International Journal of Drug Policy. 2016 ; Vol. 30. pp. 59-65.
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abstract = "Background: Despite dramatic improvement in antiretroviral therapy (ART) access globally, people living with HIV who inject drugs continue to face barriers that limit their access to treatment. This paper explores barriers and facilitators to ART initiation among clients attending a methadone clinic in Dar es Salaam, Tanzania. Methods: We interviewed 12 providers and 20 clients living with HIV at the Muhimbili National Hospital methadone clinic between January and February 2015. We purposively sampled clients based on sex and ART status and providers based on job function. To analyze interview transcripts, we adopted a content analysis approach. Results: Participants identified several factors that hindered timely ART initiation for clients at the methadone clinic. These included delays in CD4 testing and receiving CD4 test results; off-site HIV clinics; stigma operating at the individual, social and institutional levels; insufficient knowledge of the benefits of early ART initiation among clients; treatment breakdown at the clinic level possibly due to limited staff; and initiating ART only once one feels physically ill. Participants perceived social support as a buffer against stigma and facilitator of HIV treatment. Some clients also reported that persistent monitoring and follow-up on their HIV care and treatment by methadone clinic providers led them to initiate ART. Conclusion: Health system factors, stigma and limited social support pose challenges for methadone clients living with HIV to initiate ART. Our findings suggest that on-site point-of-care CD4 testing, a peer support system, and trained HIV treatment specialists who are able to counsel HIV-positive clients and initiate them on ART at the methadone clinic could help reduce barriers to timely ART initiation for methadone clients.",
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