"71 percent of women and girls who inject drugs are estimated to be living with HIV and estimates of HIV prevalence among men and women who inject drugs across the nations capital, Dar es Salaam, range from 42 percent to 50 percent in a city where overall HIV prevalence is estimated at just under 7 percent."
Various reasons were cited as to why the 264 people were no longer in the program, ranging from discharge due violation of terms of service (2%), death (3%) and patient drop out (95%). Those with the highest rates of attrition were young males, lower dose patients (less than 40mg), and those reporting a history of sexual abuse, whereas clients who were older and female were more likely to stay in the program. Another factor known to impact patient retention is dosage, which held true in this study. Notably, patients receiving a medium (41mg-85mg) to high (86mg+) dosage of methadone had much lower attrition rates than those on lower dose (40mg or less) methadone maintenance.
The success doesn't stop there. The clinic has also managed to implement important testing for certain certain communicable diseases associated with intravenous drug use, offering patients several different health services, such as HIV counselling and testing, tuberculosis testing, as well as psychological and social support services. Of the 629 total patients, 469 were tested for HIV, and of those, 185 patients did test positive.
Recommendations from the study include raising retention rates through focus on clients most at risk of attrition. Moving towards a focus on flexible options and higher dose treatment can be beneficial in retaining patients who may otherwise stray from the program. Client services and counselling can also help to address any other issues or barriers to treatment that the patients may be facing.
The first clinics achievements have rubbed off, with a second methadone facility opening in Dar es Salaam in September 2012, and plans for three more facilities in the future. The amazing success that the Dar es Salaam methadone clinic has been able to achieve should be commended. Offering those struggling with addiction access to safe, effective treatment and communicable disease testing not only benefits those struggling with addiction, but the community as a whole.