Six-month retention and changes in quality of life and substance use from a low-threshold methadone maintenance therapy programme in Durban, South Africa

Scheibe, Andrew; Shelly, Shaun; Gerardy, Tara; Homeyer, Zara von; Schneider, Andrea L.C.; Padayachee, Kalvanya; Naidoo, Shalon Balaguru; Mtshweni, Klaas; Matau, Ayanda; Hausler, Harry; Marks, Monique

doi:10.1186/s13722-020-00186-7

Cited by 21 publications

(12 citation statements)

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“…Instead, they were encouraged to re-join the project, following a medical assessment and discussion with the clinical and psychosocial team. Retention at 6 months was 81%, with a significant reduction in heroin use and a significant improvement in mental health [56]. At 12 months, retention was 74%, with notable improvements in participants' quality of life [56].…”

Section: South Africa's First Low-threshold Opioid Agonist Therapy Prmentioning

confidence: 95%

High retention in an opioid agonist therapy project in Durban, South Africa: the role of best practice and social cohesion

2020

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Background: Moral conservatism within government and communities has resulted in a reluctance to support the provision of opioid agonist therapy for people with opioid use disorders in South Africa. In April 2017, South Africa's first low-threshold opioid agonist therapy demonstration project was launched in Durban. The project provided 54 low-income people with heroin use disorders methadone and voluntary access to psychosocial services for 18 months. At 12 months, retention was 74%, notably higher than the global average. In this paper, we aim to make sense of this outcome. Methods: Thirty semi-structured interviews, two focus groups, ten oral histories and ethnographic observations were done at various project time points. These activities explored participants' pathways into drug use and the project, their meaning attributed to methadone, the factors contributing to project success and changes they experienced. Recordings, transcripts, notes and feedback were reviewed and triangulated. Key factors contributing to retention were identified and analysed in light of the existing literature. Results: The philosophy and architecture of the project, and social cohesion were identified as the main factors contributing to retention. The use of a harm reduction approach enabled participants to set and be supported to achieve their treatment goals, and was shown to be important for the development of trusting therapeutic relationships. The employment of a restorative justice paradigm provided a sense of acceptance of humanity and flaws as well as an imperative to act responsibly towards others, fostering a culture of respect. Social cohesion was fostered through the facilitation of group sessions, a peace committee and group sport (soccer). In concert, these activities provided opportunities for participants to demonstrate care and interest in one another's life, leading to interdependence and care, contributing to them remaining in the project. Conclusions: We believe that the high retention was achieved through attraction. We argue that opioid agonist therapy programmes should take the principles of harm reduction and restorative justice into consideration when designing low-threshold opioid agonist therapy services. Additionally, ways to support cohesion amongst people receiving agonist therapy should be explored to support their effective scale-up, both in low-middle income countries and in high-income countries.

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Section: South Africa's First Low-threshold Opioid Agonist Therapy Prmentioning

confidence: 95%

High retention in an opioid agonist therapy project in Durban, South Africa: the role of best practice and social cohesion

2020

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“…(30) However, small pilot studies have shown high retention rates, opiate reduction, and improvement in mental health in individuals accessing methadone treatment in South Africa. (31) Nevertheless, the lack of routine hepatitis C testing and access to PrEP indicate significant gaps in service delivery. Integration of harm reduction services into routine healthcare could impact the rising use of opiates and the HIV epidemic in South Africa.…”

Section: Discussionmentioning

confidence: 99%

High risk injection drug use and uptake of HIV prevention and treatment services among people who inject drugs in KwaZulu-Natal, South Africa

Zanoni

Milford

Sithole

et al. 2023

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The use of injection drugs in South Africa is increasing. HIV prevention, treatment and addiction services for people who inject drugs (PWID) in South Africa are not well documented. We conducted a mixed-methods study to understand current drug use practices and access to HIV prevention and treatment services for PWID in KwaZulu-Natal, South Africa. We used respondent-driven sampling to recruit 45 people who reported injecting opiates within the past 6 months from Durban, KwaZulu-Natal, South Africa. We found high rates of practices that increase HIV/viral hepatitis risk including the use of shared needles (43%) and direct blood injections (bluetoothing) (18%). Despite 35% of participants living with HIV, only 40% accessed antiretroviral therapy within the past year, and one accessed PrEP. None of the participants reported ever testing for Hepatitis C.

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“…The treatment of OUD with OAMT as part of a larger care package is supported by strong evidence globally and in South Africa (Gloeck, Harris, Webb, & Scheibe, 2020;Scheibe, Shelly, Gerardy, et al, 2020;Lize Weich, 2010;WHO, 2004). Long term use of OAMT (≥ 6 months) is associated with reduced dependence, reduced morbidity, and mortality from infectious diseases, reduced criminal behaviour, improved physical and psychological health and better social integration and functioning (Gloeck et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and treatment of opioid-related disorders in a South African private sector medical insurance scheme: a cohort study

Tlali¹,

Scheibe

Ruffieux³

et al. 2022

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BackgroundThe use of opioids is increasing globally, but data on opioid use disorder (OUD) in South Africa are scarce. This study examines the incidence of diagnosed OUD, opioid agonist use, and excess mortality among persons with OUD in South Africa’s private healthcare sector.MethodsWe conducted a cohort study of beneficiaries (≥ 11 years) of a South African medical insurance scheme using reimbursement claims from Jan 1, 2011, to Jul 1, 2020. Beneficiaries were classified as having OUD if they received opioid agonists (buprenorphine or methadone), an ICD-10 F11 diagnosis for a mental and behavioural disorder due to opioid use, or an ICD-10 T40 diagnosis for opioid poisoning. We calculated adjusted hazard ratios (aHR) for factors associated with OUD, estimated the cumulative incidence of opioid agonist use after receiving an ICD-10 F11 diagnosis, and examined excess mortality among beneficiaries with OUD.ResultsOf 1,251,458 beneficiaries, 1,313 (0.1%) had OUD. Between 2011 and 2020, the incidence of OUD increased by 12% (95% CI 9%-14%) per year. Men, young adults in their twenties, and beneficiaries with co-morbid mental health or other substance use disorders were at increased risk of OUD. The cumulative incidence of opioid agonist use was 10.6% (95% CI 8.3-13.2) at 3 years after receiving an F11 diagnosis. After adjusting for age, sex, year, medical insurance coverage, and population group, OUD was associated with an increased risk of mortality (aHR 2.29, 95% CI 1.85-2.82). OUD was associated with a 7.63-year shorter life expectancy (95% CI 4.08-10.70).ConclusionsThe incidence of patients diagnosed with or treated for OUD in the private sector is increasing rapidly. People with OUD in the private sector are a vulnerable population with substantial psychiatric comorbidity who often die prematurely. Evidence-based management of OUD is urgently needed to improve the health outcomes of people with OUD.

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Six-month retention and changes in quality of life and substance use from a low-threshold methadone maintenance therapy programme in Durban, South Africa

Cited by 21 publications

References 50 publications

High retention in an opioid agonist therapy project in Durban, South Africa: the role of best practice and social cohesion

High retention in an opioid agonist therapy project in Durban, South Africa: the role of best practice and social cohesion

High risk injection drug use and uptake of HIV prevention and treatment services among people who inject drugs in KwaZulu-Natal, South Africa

Diagnosis and treatment of opioid-related disorders in a South African private sector medical insurance scheme: a cohort study

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