access to care for hiv infected pwid what can be done

Supporting community action on HIV & AIDs and TB

Access to care for HIV infected PWID- what

can be done?

James NdimbiiKANCOCAHR/Access2Care Study

Supporting community action on HIV & AIDs and TB

Increasing Numbers of drug users in sub-Saharan Africa including Kenya Overlap of drug use and generalized HIV epidemic in the regionHigh HIV Incidence among PWID Introduction of harm reduction in Kenya (2012)

Introduction & background

Supporting community action on HIV & AIDs and TB

Three sites – Malindi (Omari Project), Ukunda (Teenswatch), Nairobi (NOSET)

Qualitative: In-depth interviews with PWID, observation, stakeholder interviews

Longitudinal: 3 waves of data collection Purposive and Theoretical sampling

Methods

Supporting community action on HIV & AIDs and TB

118 PWID33 women (29%)85 men (71%)

44 PWID reported living with HIV 16 women28 men

109 reported testing for HIV, 4 had never tested, 5 didn’t report whether or not they had tested.

Findings

Supporting community action on HIV & AIDs and TB

Managing addiction and HIV care and treatment •Requires a commitment-time and money-competing with addiction and everyday survival

‘Sometimes I go to the doctors, they give me medicine, but I have to go to [nearby town], sometimes I don’t have fees to go there.’(Alfred)

‘I queue…It is hard. If I have not recovered [managed withdrawal], it will mean I line up till one or two [pm]’. (Baba) ART Delivery at outreach project level addresses this to a large extent

Supporting community action on HIV & AIDs and TB

There is still a secrecy around HIV-people unwilling to talk about it-social stigma

‘I have many challenges, since I was sick, the challenge is not about my sickness, about the people, because some people they know that I am HIV positive, they tell me ‘Ahhh you, you are going to die, you have HIV’. (Ismail)

Supporting community action on HIV & AIDs and TB

HIV Positive PWID still likely to share injecting equipment-linked to hopelessness around being HIV infected:

‘R And when you tell them they say we are already dead I: Right how do you mean?R Yaani, they tell you they are already dead because they have already get HIV…so they use one needle for three people. (Abraham)

Supporting community action on HIV & AIDs and TB

Supporting outreach projects in delivery of ART at drop in centres makes it easier to access HIV care and treatment-better adherence outcomes Support for scale up of MAT- improves HIV treatment and care outcomes- higher coverage= more infections preventedSustained support for NSP programs even in the advent of MAT-supportive and wholesome interventions

How do we respond?

Projected impact of opioid substitution treatment (OST) on HIV prevalence and incidence at varied coverage levels.

Tim Rhodes et al. BMJ Open 2015;5:e007198

©2015 by British Medical Journal Publishing Group

Supporting community action on HIV & AIDs and TB

10

The case of Russia—Rhodes et al, British Medical Journal, 2010: 349; c3439

Impacts of policy changeImpacts of policy change

0%

25%

50%

75%

100%

10% coverage NSP 10% NSP and 10% OST coverage

10% NSP and 25% OST coverage

10% NSP and 50% OST coverage

Just NSP NSP and OST

Rel

ativ

e re

duct

ion

in H

IV in

cide

nce af

ter 5

yea

rs

OST intervention parameters

0%

25%

50%

75%

100%

10% coverage NSP 10% NSP and 10% OST coverage

10% NSP and 25% OST coverage

10% NSP and 50% OST coverage

Just NSP NSP and OST

Rel

ativ

e re

duct

ion

in H

IV p

reva

lenc

e af

ter 5

yea

rs

OST and NSP intervention parameters

Supporting community action on HIV & AIDs and TB

NOSET: Calleb Angira, Abbas Said Abdulaziz, Hussein Rama Owino, NoSET

The Omari Project: Mohammed Shosi, Athman Mohammed Famau, Alphonce Maina Thuo, Ali Omar Haji.

Teenswatch: Cosmas Maina, Athuman Bundo, Tabitha Waithera.

KANCO Sylvia Ayon, James Ndimbii

London School of Hygiene and Tropical Medicine Tim Rhodes Andy Guise

With NASCOP and NACC

The Access to Care Study