Qualitative Analysis of Community Support to Methadone Access in Kenya

Abstract

Background

Methadone, as part of Medically Assisted Therapy (MAT) for treatment of opioid dependence and supporting HIV prevention and treatment, has been recently introduced in Kenya. Few low income settings have implemented methadone, so there is little evidence to guide ongoing scale-up across the region. We specifically consider the role of community level access barriers and support.

Objectives

To inform ongoing MAT implementation we implemented a qualitative study to understand access barriers and enablers at a community level.

Methods

We conducted 30 semi-structured interviews with people who use drugs accessing MAT, supplemented by interviews with 2 stakeholders, linked to participant observation in a community drop in center within one urban area in Kenya. We used thematic analysis.

Results

We developed five themes to express experiences of factors enabling and disabling MAT access and how community support can address these: 1) time, travel and economic hardship; 2) managing methadone and contingencies of life, 3) peer support among MAT clients as treatment ambassadors, 4) family relations, and 5)outreach project contributions. Crosscutting themes address managing socioeconomic constraints and gender inequities.

Conclusions

People who use drugs experience and manage socio-economic constraints and gender inequities in accessing MAT with the support of local communities. We discuss how these access barriers could be addressed through strengthening the participation of networks of people who use drugs in drug treatment and supporting community projects working with people who use drugs. We also explore potential for how socio-economic constraints could be managed within an integrated health and social care response.

Acknowledgements

We are grateful to the support of colleagues in Kenya within various community organizations as well as the Department of Health.

Declaration of interest

Dr Frederick Owiti has advised on development of standard operating procedures for methadone delivery across Kenya. As a clinician he provides private delivery of methadone within Kenya. All other authors declare no conflicts of interest.

Ethics statement

The study had ethical approval from the University of Nairobi, University of California San Diego and London School of Hygiene and Tropical Medicine. All participants provided informed consent to participate in the study. This article is original work and has not previously been published in any other journal.