(48) Opioid Agonist Therapy Improves HIV/TB Outcomes Among PWUD/PWID in Mbeya, Tanzania

Issues: Opioid replacement therapy is successfully used to interrupt opioid dependence among people who use drugs (PWUD) and improve quality of life and HIV service uptake. Since 2011, Tanzania offers Opioid Agonist Therapy (OAT) as a methadone-based harm reduction intervention for people using opioid drugs. OAT services started in the Southern Highlands in 2017, when Mbeya Zonal Referral Hospital (MZRH) opened its OAT clinic to serve the estimated 450 PWUD living in Mbeya region.

Description: The OAT clinic at MZRH, supported by the Tanzanian MoH and PEPFAR, offers a comprehensive package of OAT; psychosocial support; peer-led community services; as well as HIV prevention, testing, and care and treatment. Additional services include testing for Hepatitis B, TB screening, and cervical cancer screening. As of June 2021, 383 PWUD/PWID used the clinic’s services and as of July 2021,173 were active clients. Among these, 27 (15.6%) clients were diagnosed with HIV and currently on ART, including 8 of the 16 female clients. All HIV-infected clients received viral load (VL) testing and 20 of them (74%) had undetectable VL. All 7 clients with high VL enrolled in enhanced adherence counseling, peer support, and directly observed ART. After three months of intervention, all clients became virally suppressed. TB screening identified 8 clients with TB disease: 6 HIV-negative and 2 living with HIV. All 8 clients started directly observed treatment (DOT) and had negative sputum tests upon TB treatment completion.

Lessons learned: HIV prevalence among PWUD in Tanzania is high and treatment adherence suboptimal. A combined approach of OAT, HIV and TB services including DOT, as well as psychosocial and community peer-led support, resulted in optimal HIV and TB treatment outcomes for all clients.

Next steps: MZRH continues to offer OAT services in its catchment area and enhance service delivery through transition to automated methadone dispensing and ongoing optimization of HIV services. As Tunduma city in Songwe region has been identified as another hot spot for opioid use, a satellite clinic has opened recently, providing OAT and HIV services to opioid drug users.

References: PEPFAR. FY2021 COP/ROP Guidance for All PEPFAR Countries, December 2020
Reddon H, Milloy MJ, Simo A, et al. . Methadone maintenance therapy decreases the rate of antiretroviral therapy discontinuation among HIV-positive illicit drug users. AIDS Behav 2014; 18:740–6.
Karki P, Shrestha R, Huedo-Medina TB, Copenhaver M. The impact of methadone maintenance treatment on HIV risk behaviors among high-risk injection drug users: a systematic review. Evid-Based Med Public Health 2016; 2:e1229.

Diversity, Equity, and Inclusion: The presentation addresses issues that are specific to semi-urban/rural communities in Tanzania and disaggregates findings by gender. People who use drugs face particular challenges and stigma when accessing healthcare and this is what our work tries to address.