JESSIE MBWAMBO PRINCIAL MEDICAL SPECIALIST AND SENIOR RESEARCHER MUHIMBILI NATIONAL HOSPITAL TANZANIA Presentation Format Know your epidemic Plan with stakeholders what needs to be done Prepare for initiation of harm reduction interventions ID: 734884
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HOW TO LAUNCH PROGRAMMES FOR PEOPLE WHO USE SUBSTANCES AND ARE AFFECTED BY HIV ACROSS MORE GENERALIZED HIV EPIDEMIC SETTINGS IN EASTERN AFRICA
JESSIE MBWAMBO,
PRINCIAL MEDICAL SPECIALIST AND SENIOR RESEARCHER, MUHIMBILI NATIONAL HOSPITAL TANZANIASlide2
Presentation Format
Know your epidemic
Plan with stakeholders what needs to be done
Prepare for initiation of harm reduction interventions
Implementation of the harm reduction interventionsSlide3
Know The East African Epidemic
In East Africa twin epidemic recognized in Kenya and Tanzania EARLY 2000s
Epidemic of Drug use due to trafficking of drugs through southern corridor
Unmanned large water border in both Kenya and Tanzania
Increasing dangerous behaviors of drug use leading to HIV acquisition
Multiple sexual partners ships to fund drug use behavior
Injection drug use
Flash bloodSlide4
The East African Country Trafficking BoardersSlide5
Know the epidemic (2)
Studies done both in Kenya and Tanzania show high HIV and HCV prevalence amongst injection drug use
Especially high prevalence amongst women drug users
In clinic settings even higher prevalence of TB infection including Multi
D
rug
R
esistant TB
Specifically in TZA 13 times the national average of 0.2%Slide6
Know Epidemic (3)
HIV
HCV
PTB
Concerns with drugs users interaction within generalized epidemics become an epi-
centreSlide7
Scenario in line with Overlapping Epidemics: Presentation at the
CREIDU
Colloquium in Melbourne 2014 by Nick Clark-WHO
Hepatitis
HIV
IDU
CREIDU-Center for Research Excellence for Injection Drug Users
7Slide8
Plan with stakeholders what needs to be done
What needs to be done:
Community Outreach workers
Longer history of existence in Kenya compared to Tanzania
Initial traditional outreach workers current peer outreach workers
Health care services engage with community services to work with people who use drugs
Newer phenomena and nobody knows how to work with thisSlide9
Health and non health talking to each otherSlide10
Prepare for start of harm reduction interventions
Integration of planned services within the health ministry infrastructure (Government Chemist, Drug and Administration institutions, Mental Health and other care services)
Integration within existing HIV and TB care
systems
Guidance documents:
Initially in TZA where the first pilot program for medically assisted treatment started then Kenya with more elaborate documentsSlide11
11Slide12
Prepare for initiation of harm reduction services
Accreditation to order methadone:
through the International Control Board-Schedule I drug (1961)
Ordering of methadone if already in your essential drug list
Maintain documentations on use
Fulfilment of reporting requirements by INCB
Preparation for national and international audit
Lobby for NSE programmes:
Kenya ahead of the curve, TZA still in pilot stage six years after initiationSlide13
Implementation of the harm reduction interventions
People who use drugs
prefer one stop setting
.
Like providers who understand them
Offer TB and ART in same clinic environment
Train providers in addiction, HIV and TB care
Offer opportunity for Drug Observed Treatment (DOT) for both TB and ARV when needed
Support other services in care of addicted patients
Offer other harm reduction materials or products at clinic site
Offer care for other dependencies that client will present with.Slide14
Family support
Overdose, HIV, Hepatitis prevention
Antiretroviral therapy
PTB care including General health care
Social assistance & protection
Mental health care
Drug dependence treatment
Drug user
MUHIMBILI NATIONAL HOSPITAL FACILITY MODEL:
CREIDU COLLOQUIUM
PPT BY NICK CLARK, WHOSlide15
Observations with harm reduction interventions
With adequate support, persons with co-morbid conditions (addiction and other physical problems) have similar outcomes as the general population
Investments in adequate care in generalized epidemics as people who use drugs maybe the possible source of the next wave of the HIV epidemic.Slide16
Thank you for listening
JMBWAMBO@GMAIL.COM