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Open AccessArticle

Evaluating the Integrated Methadone and Anti-Retroviral Therapy Strategy in Tanzania Using the RE-AIM Framework

1
Yale School of Medicine, Yale University, New Haven, CT 06511, USA
2
San Francisco Department of Psychiatry, University of California, San Francisco, CA 94118, USA
3
Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
4
Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar-Es-Salaam 11000, Tanzania
5
RTI International, San Francisco, CA 94104, USA
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2019, 16(5), 728; https://doi.org/10.3390/ijerph16050728
Received: 6 December 2018 / Revised: 14 February 2019 / Accepted: 22 February 2019 / Published: 28 February 2019
There are an estimated 50,000 people who inject drugs in Tanzania, with an HIV prevalence in this population of 42%. The Integrated Methadone and Anti-Retroviral Therapy (IMAT) strategy was developed to integrate HIV services into an opioid treatment program (OTP) in sub-Saharan Africa and increase anti-retroviral therapy (ART) initiation rates. In this paper, we evaluate the IMAT strategy using an implementation science framework to inform future care integration efforts in the region. IMAT centralized HIV services into an OTP clinic in Dar Es Salaam, Tanzania: HIV diagnosis, ART initiation, monitoring and follow up. A mixed-methods, concurrent design, was used for evaluation: quantitative programmatic data and semi-structured interviews with providers and clients addressed 4 out of 5 components of the RE-AIM framework: reach, effectiveness, adoption, implementation. Results showed high reach: 98% of HIV-positive clients received HIV services; effectiveness: 90-day ART initiation rate doubled, from 41% pre-IMAT to 87% post-IMAT (p < 0.001); proportion of HIV-positive eligible clients on ART increased from 71% pre-IMAT to 98% post-IMAT (p < 0.001). There was high adoption and implementation protocol fidelity. Qualitative results informed barriers and facilitators of RE-AIM components. In conclusion, we successfully integrated HIV care into an OTP clinic in sub-Saharan Africa with increased rates of ART initiation. The IMAT strategy represents an effective care integration model to improve HIV care delivery for OTP clients. View Full-Text
Keywords: RE-AIM; opioid; sub-Saharan Africa; key population; HIV; integration RE-AIM; opioid; sub-Saharan Africa; key population; HIV; integration
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Hassan, S.; Cooke, A.; Saleem, H.; Mushi, D.; Mbwambo, J.; Lambdin, B.H. Evaluating the Integrated Methadone and Anti-Retroviral Therapy Strategy in Tanzania Using the RE-AIM Framework. Int. J. Environ. Res. Public Health 2019, 16, 728.

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