#AIDS2016 HOW TO LAUNCH PROGRAMMES FOR PEOPLE WHO USE SUBSTANCES AND ARE AFFECTED BY HIV ACROSS MORE GENERALIZED HIV EPIDEMIC SETTINGS IN EASTERN AFRICA JESSIE MBWAMBO, PRINCIAL MEDICAL SPECIALIST AND SENIOR RESEARCHER, MUHIMBILI NATIONAL HOSPITAL TANZANIA

#AIDS2016 Presentation Format Know your epidemic Plan with stakeholders what needs to be done Prepare for initiation of harm reduction interventions Implementation of the harm reduction interventions

#AIDS2016 Know The East African Epidemic In East Africa twin epidemic recognized in Kenya and Tanzania EARLY 2000s – Epidemic of Drug use due to trafficking of drugs through southern corridor Unmanned large water border in both Kenya and Tanzania – Increasing dangerous behaviors of drug use leading to HIV acquisition Multiple sexual partners ships to fund drug use behavior Injection drug use Flash blood

#AIDS2016 The East African Country Trafficking Boarders

#AIDS2016 Know the epidemic (2) Studies done both in Kenya and Tanzania show high HIV and HCV prevalence amongst injection drug use Especially high prevalence amongst women drug users In clinic settings even higher prevalence of TB infection including Multi Drug Resistant TB Specifically in TZA 13 times the national average of 0.2%

#AIDS2016 Know Epidemic (3) HIV HCV PTB Concerns with drugs users interaction within generalized epidemics become an epi-centre

#AIDS2016 Scenario in line with Overlapping Epidemics: Presentation at the CREIDU Colloquium in Melbourne 2014 by Nick Clark-WHO Hepatitis HIV IDU CREIDU-Center for Research Excellence for Injection Drug Users 7

#AIDS2016 Plan with stakeholders what needs to be done What needs to be done: – Community Outreach workers Longer history of existence in Kenya compared to Tanzania Initial traditional outreach workers current peer outreach workers – Health care services engage with community services to work with people who use drugs Newer phenomena and nobody knows how to work with this

#AIDS2016 Health and non health talking to each other

#AIDS2016 Prepare for start of harm reduction interventions Integration of planned services within the health ministry infrastructure (Government Chemist, Drug and Administration institutions, Mental Health and other care services) Integration within existing HIV and TB care systems Guidance documents: Initially in TZA where the first pilot program for medically assisted treatment started then Kenya with more elaborate documents

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#AIDS2016 Prepare for initiation of harm reduction services Accreditation to order methadone: through the International Control Board-Schedule I drug (1961) – Ordering of methadone if already in your essential drug list – Maintain documentations on use – Fulfilment of reporting requirements by INCB – Preparation for national and international audit Lobby for NSE programmes: Kenya ahead of the curve, TZA still in pilot stage six years after initiation

#AIDS2016 Implementation of the harm reduction interventions People who use drugs prefer one stop setting. – Like providers who understand them – Offer TB and ART in same clinic environment – Train providers in addiction, HIV and TB care – Offer opportunity for Drug Observed Treatment (DOT) for both TB and ARV when needed – Support other services in care of addicted patients – Offer other harm reduction materials or products at clinic site – Offer care for other dependencies that client will present with.

#AIDS2016 Family support Overdose, HIV, Hepatitis prevention Antiretroviral therapy PTB care including General health care Social assistance & protection Mental health care Drug dependence treatment Drug user MUHIMBILI NATIONAL HOSPITAL FACILITY MODEL: CREIDU COLLOQUIUM PPT BY NICK CLARK, WHO

#AIDS2016 Observations with harm reduction interventions With adequate support, persons with co- morbid conditions (addiction and other physical problems) have similar outcomes as the general population Investments in adequate care in generalized epidemics as people who use drugs maybe the possible source of the next wave of the HIV epidemic.

#AIDS2016 THANK YOU FOR LISTENING