Methadone program participation and current ART use among people who inject drugs in Kenya

Background: In Kenya HIV prevalence among people who inject drugs (PWID) is estimated at 18% versus 5.6% in general population. To reduce opioid addiction and HIV risk, methadone was introduced in Nairobi and Kenya's coastal region in 2013. Studies in high-income countries have shown that methadone is associated with antiretrovira therapy (ART) uptake, however, it is not known whether participation in a methadone program is associated with increased ART use among PWID in Kenya. Methods: Participants were recruited from an ongoing study of Assisted Partner Services (APS) to identify, test and link to care the sexual and injecting partners of HIV-positive PWID in Kenya. Recruitment for index participants was done from NSP programs and methadone clinics in Nairobi, Kilifi and Mombasa countie where they were receiving HIV care. In this study we interviewed all HIV-positive index participants who had injected drugs in the last one year about linkage to care, ART uptake, methadone use and current injecting practices. We used logistic regression to evaluate associations between methadone program participation and current ART use, adjusting for demographic and behavioral characteristics. Results: A total of 668 HIV-positive index participants were enrolled. Of these, 138 (21%) were on methadone and 527 (79%) reported they were taking ART. The majority of participants were male (52%) and median age was 36 years (IQR 31 to 42). Of 138 currently enrolled in methadone programs, 128 (93%) were on ART compared to 399 (75%) of the remaining 530 not taking methadone. After adjusting for age, sex, marital status, and living conditions, those on ART were over 4 times more likely to take methadone (adjusted Odds Ratio [aOR] = 4.21, p < 0.001). Of 346 men 89 (26%) were on methadone compared with 49 (15%) of 322 women (aOR = 0.45, p < 0.001). Women were also less likely to be on ART compared to men although this difference was not statistically significant (aOR = 0.72, p = 0.08). Conclusions: Methadone use was strongly associated with reported ART use amongst PWID in Kenya. Women were significantly less likely than men to take methadone and were also less likely to be taking ART. These findings can guide policies and practices for targeted methadone support programs in Kenya.
OA21.02 L. Mbogo (1); A. Monroe-Wise (2); B. Sambai (1); B. Guthrie (2); D. Bukusi (3); W. Sinkele (4); P. Macharia (5); N. Ludwig (6); J. Herbeck (6); M. Dunbar [...]