Qualitative Analysis of Community Support to Methadone Access in Kenya

James Ndimbii; Andy Guise; Emmy Kageha Igonya; Frederick Owiti; Steffanie Strathdee; Tim Rhodes

doi:10.1080/10826084.2021.1922450

Qualitative Analysis of Community Support to Methadone Access in Kenya

James Ndimbii^*, Andy Guise, Emmy Kageha Igonya, Frederick Owiti, Steffanie Strathdee, Tim Rhodes

^*Corresponding author for this work

Population Health Sciences

Research output: Contribution to journal › Article › peer-review

4 Citations (Scopus)

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.

Original language	English
Pages (from-to)	1312-1319
Number of pages	8
Journal	Substance Use and Misuse
Volume	56
Issue number	9
DOIs	https://doi.org/10.1080/10826084.2021.1922450
Publication status	Accepted/In press - 2021

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@article{f91d4ecd448a4613b29b5b50dce63877,

title = "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.",

author = "James Ndimbii and Andy Guise and Igonya, {Emmy Kageha} and Frederick Owiti and Steffanie Strathdee and Tim Rhodes",

note = "Funding Information: We are grateful to the support of colleagues in Kenya within various community organizations as well as the Department of Health. Publisher Copyright: {\textcopyright} 2021 Taylor & Francis Group, LLC. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",

year = "2021",

doi = "10.1080/10826084.2021.1922450",

language = "English",

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pages = "1312--1319",

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T1 - Qualitative Analysis of Community Support to Methadone Access in Kenya

AU - Ndimbii, James

AU - Guise, Andy

AU - Igonya, Emmy Kageha

AU - Owiti, Frederick

AU - Strathdee, Steffanie

AU - Rhodes, Tim

N1 - Funding Information: We are grateful to the support of colleagues in Kenya within various community organizations as well as the Department of Health. Publisher Copyright: © 2021 Taylor & Francis Group, LLC. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021

Y1 - 2021

N2 - 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.

AB - 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.

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ER -

Qualitative Analysis of Community Support to Methadone Access in Kenya

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