Early findings from a Kenyan-UK-US research partnership

A new study (May 2015) by the London School of Hygiene and Tropical Medicine (LSHTM) and the Kenyan Consortium of AIDS Non-Government Organisations (KANCO) provides evidence of the potential impact of methadone maintenance treatment in the prevention and treatment of HIV among people who inject drugs. The research, which used mixed method approaches, appears in the January 2015 issue of the BMJ Open Access journal.

Heroin use is an increasing public health challenge in Kenya and the country is witnessing a growing contribution to national HIV incidence resulting from unsafe drug injecting practices. HIV prevalence among people who use drugs is estimated to be as high as 50% in Nairobi and 20% in the Coastal Province. 

To meet this challenge, in 2013 the Kenyan Ministry of Health, the Kenyan Consortium of AIDS Non-Government Organisations (KANCO) and the Alliance began introducing community-based and peer-led health services for people who inject drugs (PWID) as part of a multi-country Community Action on Harm Reduction programme.[1] These services included clean needles and syringes and overdose prevention programmes. Since 2014, a methadone or opioid substitution treatment (OST) programme has been introduced by the Kenyan Government. OST is one of the key features of the WHO/UNODC/UNAIDS essential harm reduction package for the prevention and treatment of HIV amongst PWID.

The global evidence for the effectiveness of methadone to treat opiate dependency and to prevent HIV transmission is strong. However, little is known about methadone programming and its impact in Africa. Kenya is only the third Sub-Saharan African country to introduce large scale methadone programming. For many PWID in Kenya, their hopes are invested in methadone, seeing it as a route to a life without the difficulties associated with illicit opiate use such as problems with police and homelessness.

Using mathematical modelling along with qualitative sociological research the researchers set out to understand what is the ‘promise’ of methadone for Kenya? What are the hopes and expectations that surround its introduction?

Findings

Through the modelling the researchers were able to predict a reduction in HIV incidence and prevalence among people who inject drugs linked to the implementation of OST, especially if OST is delivered at scale. However, it was noted that a relatively high level of sexual transmissions in a generalised epidemic setting may moderate this impact.

The qualitative research (190 interviews with PWID, and 43 with stakeholders) showed evidence of different and conflicting expectations in relation to the ‘promise’ of methadone. Participants perceive methadone as providing either a hope and means of recovering from dependency (primarily the individual and community narratives) or as a means of HIV prevention (the policy narratives).

Nell Freeman for the Alliance Impact on community programming

“In commissioning this study, we wanted to understand how to make methadone programming work best in Kenya,” said Susie McLean, senior advisor on drug use and HIV at the Alliance. “From these results we understand better the importance of building and managing expectations around methadone. It also underlined the need to intensify efforts towards the prevention of sexual transmission of HIV for PWID and their partners. Our Linking Organisations and other community based organisations are able to refine and modify interventions to reflect these needs and concerns. Methadone is an enormously helpful intervention, but it’s not a magic bullet.”

A Kenyan-UK-US research partnership

LSHTM and the Alliance are working with KANCO to research the best way to introduce methadone in Kenya. At the centre of delivering OST are KANCO and two community-based organisations – The Omari Project and Nairobi Outreach Services Trust. KANCO are also working with the University of Nairobi, the National AIDS Control Council and the National AIDS and Sexually Transmitted Infections Control Programme. From further afield the The Centre for AIDS Research at the University of California San Diego is contributing their expertise.

Research at the Alliance

We use our extensive community-based experience to contribute to high impact HIV research. You can find more examples here

We are part of a number of partnerships with academic institutions, and our Research Think Tank comprises programming and research staff from Alliance Linking Organisations and helps us to share our evidence and improve learning.

 [1] Open Society Foundation and Mainliners (as part of the Bridging the Gap programme) were part of the effort to establish harm reduction in Kenya also.