Tanzania's First Methadone Clinic A Smashing Success
In 2011, the Tanzanian government took the amazing step forward of opening the country's first methadone maintenance clinic, and a new study is highlighting the huge successes the program has achieved thus far.
Prior to the clinics opening in the country's largest city, Dar es Salaam, Tanzania was struggling with a growing epidemic of people who inject drugs. Home to approximately 50,000 intravenous drug users (particularly heroin) and facing the complex issues of needle sharing and condomless sex; the prevalence rates of HIV began to increase at alarming rates.
"71 percent of women and girls who inject drugs are estimated to be living with HIV and estimates of HIV prevalence among men and women who inject drugs across ... Dar es Salaam range from 42 percent to 50 percent in a city where overall HIV prevalence is estimated at just under 7 percent."
But after only 2 years in operation, amazing things have begun to happen. In that short period of time, with funding assistance from the U.S. President’s Emergency Plan for AIDS Relief, the methadone maintenance clinic located in a national hospital in Dar es Salaam managed to serve 629 people who were struggling with an addiction to opiates. Not only that, but they have managed to retain more than half of those patients over the course of 2 years in operation, which is an attrition rate comparable to programs in other countries.
Various reasons were cited as to why the 264 people were no longer in the program, ranging from discharge due violation of terms of service (2 percent), death (3 percent) and patient drop out (95 percent). Those with the highest rates of attrition were young males, lower dose patients (less than 40mg), and those reporting a history of sexual abuse, whereas clients who were older and female were more likely to stay in the program. Another factor known to impact patient retention is dosage, which held true in this study. Notably, patients receiving a medium (41mg-85mg) to high (86mg+) dosage of methadone had much lower attrition rates than those on lower dose (40mg or less) methadone maintenance.
The success doesn't stop there. The clinic has also managed to implement important testing for certain communicable diseases associated with intravenous drug use, offering patients several different health services, such as HIV counselling and testing, tuberculosis testing, as well as psychological and social support services. Of the 629 total patients, 469 were tested for HIV, and of those, 185 patients did test positive.
Recommendations from the study include raising retention rates through focus on clients most at risk of attrition. Moving towards a focus on flexible options and higher dose treatment can be beneficial in retaining patients who may otherwise stray from the program. Client services and counselling can also help to address any other issues or barriers to treatment that the patients may be facing.
The first clinic's achievements have rubbed off, with a second methadone facility opening in Dar es Salaam in September 2012, and there are plans for three more facilities in the future. The amazing success that the Dar es Salaam methadone clinic has been able to achieve should be commended. Offering those struggling with addiction access to safe, effective treatment and communicable disease testing not only benefits those immediately impacted, but the community as a whole.