TY - JOUR
T1 - Treatment of an HIV-affected adolescent with heroin dependence in a low-income country
T2 - A clinical case study from Zambia
AU - Akiba, Christopher
AU - Kane, Jeremy C.
AU - Skavenski van Wyk, Stephanie
AU - Paul, Ravi
AU - Mukunta, Chombalelo
AU - Murray, Laura K.
N1 - Funding Information:
Informed consent was obtained from the patient and his caregiver before enrollment into the trial and additional oral permission was obtained following his participation in the trial to publish the details of his treatment anonymously in this case report. Both the randomized trial and this case report were approved by the Johns Hopkins Bloomberg School of Public Health and University of Zambia Biomedical Research Ethics Committee. Research reported in this publication was supported by The Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health under award number R01HD070720-01. Publication of this article was also supported by the UK Department for International Development and the South Africa Medical Research Council (#52069) as part of the What Works to Prevent Violence against Women and Girls Programme.
Publisher Copyright:
© 2018 The Authors
PY - 2018/12
Y1 - 2018/12
N2 - Introduction: Although the World Health Organization (WHO) has recommended guidelines for the treatment of opioid dependence, there are myriad challenges to successfully implementing such guidelines in resource constrained settings, such as in low and middle-income countries (LMICs). To highlight these challenges, this paper presents a clinical case study of an adolescent study participant in a randomized controlled trial comparing two counseling programs in Lusaka, Zambia. Case description: This 15 year-old male reported smoking marijuana and heroin daily, and injecting heroin monthly (while needle sharing). The patient was linked to the only physician capable of treating heroin addiction in Zambia. The patient was placed on a 30-day detox regimen of Tramadol administered from home, as in-patient detox services are unavailable in Zambia. The patient experienced complications with out-patient detox, including a relapse that led to violent behavior and temporary incarceration. The patient's treatment regimen was altered to include Lorazepam, a mild sedative, and psychosocial counseling. After completing detox the client was prescribed Naltrexone for maintenance as Methadone is listed as a banned substance in Zambia, and Buprenorphine is not available and is cost prohibitive. Conclusions: Despite a considerable amount of time and resources expended to successfully treat the patient, the majority of WHO guidelines for opioid dependence treatment were not attainable within the Zambian context. Additional research into the effectiveness and implementation of evidence-based interventions for substance use in LMICs is warranted.
AB - Introduction: Although the World Health Organization (WHO) has recommended guidelines for the treatment of opioid dependence, there are myriad challenges to successfully implementing such guidelines in resource constrained settings, such as in low and middle-income countries (LMICs). To highlight these challenges, this paper presents a clinical case study of an adolescent study participant in a randomized controlled trial comparing two counseling programs in Lusaka, Zambia. Case description: This 15 year-old male reported smoking marijuana and heroin daily, and injecting heroin monthly (while needle sharing). The patient was linked to the only physician capable of treating heroin addiction in Zambia. The patient was placed on a 30-day detox regimen of Tramadol administered from home, as in-patient detox services are unavailable in Zambia. The patient experienced complications with out-patient detox, including a relapse that led to violent behavior and temporary incarceration. The patient's treatment regimen was altered to include Lorazepam, a mild sedative, and psychosocial counseling. After completing detox the client was prescribed Naltrexone for maintenance as Methadone is listed as a banned substance in Zambia, and Buprenorphine is not available and is cost prohibitive. Conclusions: Despite a considerable amount of time and resources expended to successfully treat the patient, the majority of WHO guidelines for opioid dependence treatment were not attainable within the Zambian context. Additional research into the effectiveness and implementation of evidence-based interventions for substance use in LMICs is warranted.
KW - HIV
KW - Heroin
KW - Low- and middle-income country
KW - Orphans and vulnerable children
KW - Substance abuse
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U2 - 10.1016/j.abrep.2018.09.003
DO - 10.1016/j.abrep.2018.09.003
M3 - Article
C2 - 30505923
AN - SCOPUS:85055705518
SN - 2352-8532
VL - 8
SP - 170
EP - 175
JO - Addictive Behaviors Reports
JF - Addictive Behaviors Reports
ER -