Participation in methadone programs improves antiretroviral uptake and HIV viral suppression among people who inject drugs in Kenya

Abstract

Background: HIV prevalence among people who inject drugs (PWID) in Kenya is estimated to be 18% compared to 4.5% in the general population. Studies from high-income countries have demonstrated that methadone use is associated with increased uptake of antiretroviral therapy (ART) and higher rates of viral suppression among PWID with HIV. However, it is unclear whether methadone use has the same effect among African PWID living with HIV. Methods: We performed a cross-sectional study to evaluate associations between methadone program participation and ART uptake and viral suppression (HIV RNA viral load <1000 copies/ml) among PWID with HIV in Kenya. Participants were recruited from needle and syringe programs and methadone clinics, interviewed on site, and samples were obtained and assayed for HIV viral loads. Univariate and multiple logistic regression were used to determine associations. Results: Among 679 participants, median age was 37 years, 48% were female, and 24% were in a methadone program. We observed higher proportions of ART use (96% vs. 87%, p = 0.001) and HIV viral suppression (78% vs. 65%, p = 0.012) among PWID on methadone compared to those not on methadone treatment. PWID who were not participating in a methadone program were 3-fold more likely to be off ART and approximately twice as likely to be viremic compared to those in methadone programs (adjusted odds ratio [aOR] = 3.35, 95% confidence interval [CI]: 1.35-8.35 and aOR = 1.90, 95% CI: 1.03-3.52, respectively). Conclusions: In this study, Kenyan PWID living with HIV participating in a methadone treatment program were more likely to be on ART and to have achieved viral suppression. Scale-up of methadone programs may have a positive impact on HIV epidemic control for this key population.

Peer community health workers improve HIV testing and ART linkage among key populations in Zambia: retrospective observational results from the Z‐CHECK project, 2019–2020

“…However, a survey in Mozambique reported that among HIV‐infected PWID participants, 80% had previously been tested for HIV, 63% were aware of their HIV status and 49% ( n = 100) reported being linked to care for their HIV infection [ 38 ]. In Kenyan PWID on methadone, ART linkage was reported to be 96% [ 39 ]. Documented linkage was relatively high (77–79%) among Hispanic PWID populations in the United States; however, the linkage was only 32% among PWID in India [ 37 ].…”

Exploring the experiences of clients receiving opioid use disorder treatment at a methadone clinic in Kenya: a qualitative study

“…In Kenya, it is estimated that there are 18,000 to 30,000 injecting drug users, most of whom use heroin with an HIV prevalence more than three times that of the general population [ 19 ]. This prompted the government in association with partners to introduce methadone treatment as a harm reduction strategy in 2014 in Nairobi [ 20 , 21 ] with current eight methadone treatment clinics in various regions of the country.…”

“…Limited research has been done to assess the implementation of methadone treatment in Kenya. Previous studies among individuals on methadone treatment include a study at a community-based drop-in centre related to client perception of accessibility to methadone treatment [ 18 ]; understanding of the integration of HIV services with methadone [ 21 ]; assessment of transition from smoking to injection drug use [ 22 ]; impact of needle syringe exchange program on injection drug use [ 23 ]; and effect of methadone treatment on ART uptake and viral suppression among people who inject drugs [ 19 ]. However, no study in Kenya has described the experiences of patients receiving methadone treatment at a methadone treatment clinic.…”