The Role of Context in Integrating Buprenorphine into a Drop-In Center in Kampala, Uganda, Using the Consolidated Framework for Implementation Research

Abstract

Background: Although Africa has long borne the brunt of the human immunodeficiency virus (HIV) epidemic, until recently, the continent has been considered largely free of illicit drug use and injection drug use in particular. In Uganda, the number of people who use or inject drugs (PWUD and PWID, respectively) has increased, and PWID are a key population at high risk for human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection. However, harm reduction practices, including providing clean injection equipment and medication-assisted treatment (MAT), have only recently been piloted in the country. This project aims to integrate buprenorphine into a harm reduction drop-in center (DIC). Methods: The Consolidated Framework for Implementation Research was used to guide our preparations to integrate buprenorphine into existing practices at a harm reduction DIC. We conducted key informant interviews with members of a community advisory board and DIC staff to document this process, its successes, and its failures. Results: Results indicate that criminalization of drug use and stigmatization of PWUD challenged efforts to provide buprenorphine treatment in less regulated community settings. Conclusions: DIC staff and their commitment to harm reduction and advocacy facilitated the process of obtaining necessary approvals.

“Take services to the people”: strategies to optimize uptake of PrEP and harm reduction services among people who inject drugs in Uganda

“…Harm reduction interventions focusing on decreasing risks without advocating abstinence from drug use have proven effective in reducing HIV transmission among PWID [10,11]. Examples of successful programs include needle and syringe programs (NSP) that prevent the sharing of injecting equipment and medications for opioid use disorder (MOUD) which aim to minimize drug use among those using opioids [12]. In Uganda, the Narcotic Drugs and Psychotropic Substances (Control) Act, 2016 regards drug possession and trafficking as unlawful activities [13].…”