Medication Assisted Treatment Program in Tanga: A Crucial Tool in the Battle against HIV among PWID

According to the UNODC World Drug Report of 2020, an estimated 15.6 million people inject drugs (PWID) globally, and 30% are women. PWID often experience challenges related to stigma, rejection, imprisonment, and many other mental health issues. PWID are among the most vulnerable populations in the battle against HIV due to the high risk of HIV transmission associated with injection drug use.

Through the Afya Kamilifu Project, funded by the United States President’s Emergency Plan for AIDS Relief (PEPFAR) through the United States Centers for Disease Control and Prevention (CDC) Tanzania, Amref Health Africa in Tanzania is supporting the Ministry of Health in implementation of medication-assisted treatment (MAT) in Tanga Region. The intervention is implemented by the Tanga Free Drug Foundation and the Gift of Hope, which are local civil society organizations (CSOs), at Tanga Regional Referral Hospital, in collaboration with the Ministry of Health (MOH) and the Drug Control and Enforcement Authority (DCEA).

The MAT program at Tanga Regional Referral Hospital significantly advances the battle against HIV in Tanzania. The program offers MAT services to PWID and has become an essential tool for HIV prevention and treatment. To prevent HIV and other adverse effects from injection opioid use, the MAT program aims to reduce or end opioid use. The MAT clinic provides PWID with integrated treatment, such as opioid replacement therapy (methadone), HIV testing, counselling and linkage to care, tuberculosis, hepatitis screening and treatment, psychosocial counselling, and behaviour change programs. These interventions are all provided free of charge to reduce the risk of contracting and transmitting HIV.

According to Dr. Selemani Msangi, the Tanga Regional AIDS Coordinator, as of April 2023, more than 500 people were receiving MAT services at the clinic, and more than 40 are HIV-positive. “The number of people newly diagnosed with HIV in the region has significantly decreased since they began providing MAT services. By giving PWID a safe and supportive environment, we can educate them on the significance of HIV prevention and provide them with access to testing and treatment,” says Dr. Selemani.

Comprehensive MAT services at Tanga Regional Referral Hospital (TRRH) include Comprehensive MAT services at Tanga Regional Referral Hospital (TRRH) include counselling, daily methadone doses, and involvement of the client’s family. This is achieved through community engagement by CSOs who identify PWID from hotspot areas in the community. These PWID are then referred to drop-in centers for PrE MAT services enrollment. CSOs using Community Volunteers (COVs) at the drop-in centers refer eligible PWID to TRRH for physical reassessment and enrollment into MAT services, following the National Guidelines.

Once enrolled in MAT services, individuals continue to attend the drop-in centres for SBCC (Social and Behavior Change Communication), counselling, and participation in social groups. Additionally, there are income-generating activity groups overseen by site managers, with some funding currently provided by Tanga Councils.

Amref Tanzania, with funding from PEPFAR through CDC, provides technical assistance to healthcare providers (HCPs) and community outreach volunteers (COVs) through on-the-job training, mentorship, and joint supportive supervision. In addition to technical assistance, it facilitates the availability of MAT supplies such as disposable cups, safe and clean drinking water, urine drug test/screening (UDS), and osmotic water machines. Other forms of support include extra duty allowances for HCPs, incentives for COVs, rent and utilities for the drop-in centres, HCPs participating quarterly in the Technical Working Group (TWG), and monthly stakeholder meetings. Amref Tanzania also engages with the friends of PWIDs to trace missed doses or follow-ups.

In the battle against HIV in Tanzania, Dr. Edwin Kilimba, Project Director for Afya Kamilifu, has stressed the significance of these services. “We offer technical assistance for HIV testing, TB screening and treatment, psychosocial counselling, and behaviour change. The project also funded the refurbishment and operationalization of the previous MAT service rooms and training for 12 MAT service providers and CSOs,” according to Dr. Kilimba.

Tanga Regional Referral Hospital MAT clinic’s site manager, Dr. Wallace Karata, notes that the facility offers PWIDs a secure and encouraging atmosphere. “Clients are linked to the clinic through the two CSOs operating in Tanga District. As soon as they begin treatment, they sign the contract and pledge to abide by its guidelines. The clinic keeps an eye on them and encourages them to adhere to treatment,” Dr. Karata said. In Karata’s opinion, the goal is to assist these people in changing, learning about their health state, and achieving social acceptance. Since the clinic began offering MAT services in June 2020, 15 patients have graduated in treatment and are now successful contributing members of society.

The Tanga Free Drug Foundation Chairman, Bakari Mwindad, claims the foundation has effectively reached PWIDs in their neighbourhoods. He says this has been accomplished through speaking with, teaching, and connecting them to MAT clinics. The success stories of program participants who have overcome addiction and are now leading healthier lives, like Otu Oka and Menci Rali, demonstrate the program’s effectiveness.

Otu Oka, not his real name, a client of the MAT clinic, states that he had been battling addiction for more than 20 years before visiting the facility. His life has improved significantly because of the MAT services. Now that he has recovered, he is more knowledgeable about HIV/AIDS prevention strategies for himself and others.

Another former PWID, Menci Rali, said it took the Tanga Free Drug Foundation seven years to find her and introduce her to methadone treatment at the MAT clinic. She decided to begin the treatment, and as a result, she is now a better person, conscious of her health, living with her spouse, married, and taking care of her kid at home.

According to Dr. George Mgomella, the Associate Director of Programs, CDC is proud to collaborate with Amref Tanzania to implement the MAT clinic in Tanga through different forms of support. This support includes technical assistance to Amref Tanzania and healthcare providers, allocating funds for KP MAT services, monitoring program implementation through physical, virtual, and WhatsApp group communication, and achieving the set targets.

The MAT services have significantly reduced HIV transmission among people who inject drugs in the Tanga Region.

MAT clinics are an essential part of Tanzania’s HIV response. The clinics’ effects are seen in every aspect of the community. By reducing new HIV infections, MAT interventions will contribute to eliminating AIDS by 2030. Therefore, using methadone is one of the HIV-preventative strategies for attaining HIV epidemic control.

Written by Julieth Mongi and Adrian Mgaya, Amref Health Africa in Tanzania