Implementation Science in HIV Related Work: Case Study of Injection Drug Users Intervention in Tanzania
- 1. Jessie Mbwambo, Muhimbili National Hospital (MNH) and Muhimbili University of Health and Allied Sciences (MUHAS)
- 2. Presentation format What is Implementation Sciences What is the value of Implementation Science Background to the Injection Drug Use in the region Implementation science for injection drug users —The case study of a methadone treatment program Research questions for Implementation Sciences for Injection Drug Users
- 3. Definition of Implementation Sciences (IS) to translate effective IS is the study of approaches interventions into health care policy and practice. IS draws from a variety of different research disciplines including epidemiology, biostatistics, anthropology, sociology, health policy, health economics, management sciences, mathematical modeling, community engagement and ethics. Using these methodologies with HIV programs, IS identifies, develops and measures the impact of innovative strategies to improve HIV service delivery, thereby strengthening the global AIDS response.
- 5. IS Framework 1 To begin addressing IS questions, a clear understanding of the gaps in HIV for KP programs must be developed. Establish and strengthen M&E and surveillance systems that facilitate identification of bottlenecks, gaps and missed opportunities in KP program delivery .
- 6. IS Framework 2 Effective translation of evidence into practice via relationships and activities between communities that facilitate the delivery of health services and health interventions
- 7. IS Framework#2 be targeted among the Deciding where change(s) must components of health care system and what are the best approaches for inducing change, whether organizational, social or individual levels. Formulating new approaches where teams should consider the context of the linkages, interactions, relationships and behaviors of the components of the system of health care under investigation . Development of strategies and approaches that can be translated to other settings allowing for local adaptation as appropriate.
- 8. IS Framework 3 Engaging researchers who have experience in developing studies to answer IS questions critical Research personelle to be familiar to using multiple methodologies to answer questions Using cost data and analysis of data to understand the relative efficiency of different approaches by measuring and comparing the costs and consequences of different strategies.
- 9. IS Framework 4 Success of IS initiatives is when research findings are used to improve programs and tailor policies when lessons have been learned. IS initiatives should include a plan for how to achieve this with understanding that the approach will change along the way. Considerations of how to address a programmatic gap or measure that impact the new strategy
- 10. IS framework 4………. Approaches used to accomplish these goals will vary from situation to situation. understanding what ways the results from a particular initiative should be utilized – including polices at a national, regional or global level is critical strategic planning within service delivery systems (i.e., clinics or hospitals) or program strategies among community-based organizations – should also be understood.
- 13. Injecting drug users and HIV reported presence Globally 151 countries have of Injection Drug Use 15.9 million people inject drugs 3million of those are HIV infected No population estimates in many countries of SSA HIV reported in many small scale studies In Tanzania using snow ball format rates between 42-51% among PWID Constellation of multiple risky behaviours possibly crossing into general reported in Kenya, cannot be different elsewhere
- 14. Prevention of HIV among PWIDS in Dar es Salaam Program entitled “Reducing HIV/AIDS transmission in people who inject drugs their sexual and injecting networks in Dar es Salaam, Tanzania” Started 2009 through Cooperative Agreement to MUHAS from CDC with funding from the PEPFAR
- 15. Prevention#2 TAPP at the forefront of efforts in subSaharan Africa to address HIV transmission among people who inject drugs and their social networks. Used a combination approach to HIV prevention for PWIDs TAPP created an outreach program with Tanzanian non-governmental organizations (NGOs) that uses a variety of communitybased, clinical and state level interventions to address different levels of vulnerability
- 16. Injection drug users programing at MUHAS
- 17. Identify programmatic gaps Used program data to raise questions: TB screening and diagnosis: Active Case Finding for Tuberculosis among People Who Inject Drugs on Methadone Treatment in Dar es Salaam, Tanzania Where do we loose women in the cascade to MAT: Understanding Barriers to Methadone Assisted Therapy Among Female Heroin Users in Dar es Salaam, Tanzania Who are the defaulters when using methadone: Methadone Dose, Age and History of Abuse Impact Clients’ Risk of Defaulting from Methadone Treatment in Dar es Salaam, Tanzania
- 18. Identifying program gaps 2 delivery: Methadone Inequities in health care Treatment for HIV Prevention-Feasibility, Retention and Predictors of Defaulting in Dar es Salaam, Tanzania: A Retrospective Cohort Study What is the quality of life of those on methadone: Quality of life among people who inject drugs attending Muhimbili Methadone Clinic in Dar-esSalaam How to maximize utilization at MAT to prevent HIV: Providing Medication Assisted Treatment (MAT) as an HIV Prevention Intervention: Programmatic Strategies to Maximize Service Utilization in Dar es Salaam, Tanzania
- 19. Developing and implementing strategies TB screening and diagnosis: Use GeneXpert gives real time results can even work with low quantity of microbes in sputum and results within short time Where do we loose women in the cascade to MAT: Night time community out reach work and economic empowerment Who are the defaulters when using methadone: Young people give “older peers” as treatment supporters; people on low doses have doses increased
- 20. IS 3 and IS 4 IS 3: Measuring effectiveness and efficiency Young program not yet there IS 4: Utilizing information Young program not yet there
- 22. Research Gaps Surveys (IBBS) needed to Integrated Bio Behavioural have a denominator for the 50% needed for interventions done to make it possible for turning the tide of the HIV epidemic among PWIDs What cadres and quantities of human resource for health are required for implementing comprehensive services for PWIDs Evaluation of interventions as is outlined a main option Pre and post test utilization designs (depends on corrections of previous observations) Mental and social outcomes for PWIDS in and not in treatment
Editor's Notes
- #6: Effective delivery of HIV prevention, care and treatment requires many interactions of clients with community-based and clinic-based services, and therefore, programs must be able to assess the flow of patients through and between delivery systems.
- #9: What is most cost effective for effective intervention: take home doses for methadone clients or dosing at window for all of 90 days that they visit clinic