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Treatment and prevention: integrated methadone and antiretroviral therapy among people who inject drugs in Dar es Salaam, Tanzania


The first study (Aim 1) documented the visit process and care delivery in relation to the IMAT intervention. This study documented variation in the time patients spend receiving various clinic services, as well as variation in the types of services providers engage in. Results from this research aim also show variation in the degree to which patients received integrated care. The second study (Aim 2) examined the impact participation in the IMAT intervention had on patient attendance at the methadone clinic. Results indicate that participation in IMAT had a positive effect on patient attendance.

The third study (Aim 3) examined patient and provider perceptions of the IMAT intervention to better understand factors that might have influenced their participation. Providers felt the ability of the intervention to incorporate patient needs, fit into clinic procedures, and evidence for the effectiveness of the intervention had a positive influence on implementation effectiveness. Strong positive influences included adaptability, and perceptions of the advantage of implementing IMAT compared to alternative solutions. Resources dedicated to intervention such as physical space and time presented a challenge to implementation effectiveness. Patients felt the ability to receive anti-retroviral medication in the clinic made it easier for them to receive care. Patients identified challenges to implementation, such as clinic resources, consistent access to nutrition, and concerns about stigma from their fellow patients. Patients enrolled in IMAT felt positively about the program overall, indicating that IMAT improved care receipt, and streamlined the care process.

Implementing HIV care and treatment and methadone treatment concurrently in health care settings with marginal resources poses a challenge. Access and availability of treatment is an important issue when considering the link between injection drug use and HIV, especially for those who are HIV positive. While it is possible to implement this intervention in this setting attention should be placed on issues of care retention and attendance. This dissertation seeks to better understand these issues outside of a western care context, with the hopes of documenting core components.

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