CONCOMITANT HEROIN USE AMONG RECIPIENTS OF MEDICALLY (METHADONE) ASSISTED THERAPY ENROLLED IN MALINDI SUB-COUNTY HOSPITAL

Abstract

Concomitant Heroine Use (CHU) negatively impacts the success of Medically (Methadone) Assisted Therapy (MAT) against substance abuse among addicts. We aimed to assess the prevalence, risks factors and context of CHU among MAT recipients at the Malindi Sub- County Hospital. A mixed methods design involving quantitative and qualitative methods was used. A convenient cross sectional sample of persons who used drugs (PWUDs) and on MAT were recruited. Quantitative work involved interviewer administered questionnaires among PWUDS (N=156), whilst qualitative work included focused group discussions (FGDs, N=2) amongst care providers (N=24). CHU was determined based on a rapid urine drug test from urine samples. Of the 156 participants, 38 (24%) were female, median age 35 years. Overall CHU was 30.1% (95% confidence interval (CI): 23.0-38.0); 31.3% (37/118) among men and 26.3% (10/38) among women (p=0.6). Self-reported heroine-use in the last month was 27.1% for men, and21.1% for women (p=0.5). In multivariate regression, adjusted for age, gender, and education, sex work in the previous 3 months (Adjusted odds ratio (aOR): 5.3 (95% CI: 1.5-18.9), and history of defaulting (aOR: 3.0 (95%CI: 1.4-6.7) were strongly associated with CHU. While clinic and support staff had the impression that CHU was low, three out of ten MAT clients in Malindi used heroine concomitantly. Perceived challenges included poor psychosocial counseling adherence and lack of enough resources. Care providers suggested systematic education strategies to empower PWUDs towards harm reduction, including abstinence to CHU. High levels (30%) of CHU were observed amongst PWUDs on the Methadone programme in this setting. CHU continues across MAT attendees despite, the perception that CHU gradually reduces. Sex work and defaulting were strongly associated with CHU, therefore vi interventions aimed at addressing the two and customized package of care to improve MAT adherence will further help reduce CHU. Keywords: Concomitant Heroin Use, Sex Work, Defa