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"Take services to the people": strategies to optimize uptake of PrEP and harm reduction services among people who inject drugs in Uganda.
Kamusiime, Brenda; Beima-Sofie, Kristin; Chhun, Nok; Nalumansi, Alisaati; Nalukwago, Grace Kakoola; Kasiita, Vicent; Twesige, Chris Collins; Kansiime, Ritah; Muwonge, Timothy R; Kyambadde, Peter; Kadama, Herbert; Mudiope, Peter; Glick, Sara; Lambdin, Barrot; Mujugira, Andrew; Heffron, Renee.
Afiliação
  • Kamusiime B; Infectious Diseases Institute, Makerere University, Kampala, Uganda.
  • Beima-Sofie K; Department of Global Health, University of Washington, 3980 15th Ave NE, Box 351620, Seattle, WA, 98195, USA. beimak@uw.edu.
  • Chhun N; Department of Global Health, University of Washington, 3980 15th Ave NE, Box 351620, Seattle, WA, 98195, USA.
  • Nalumansi A; Infectious Diseases Institute, Makerere University, Kampala, Uganda.
  • Nalukwago GK; Infectious Diseases Institute, Makerere University, Kampala, Uganda.
  • Kasiita V; Infectious Diseases Institute, Makerere University, Kampala, Uganda.
  • Twesige CC; Infectious Diseases Institute, Makerere University, Kampala, Uganda.
  • Kansiime R; Most-At-Risk Populations Initiative (MARPI), National STI Control Unit, Kampala, Uganda.
  • Muwonge TR; Infectious Diseases Institute, Makerere University, Kampala, Uganda.
  • Kyambadde P; Most-At-Risk Populations Initiative (MARPI), National STI Control Unit, Kampala, Uganda.
  • Kadama H; Ministry of Health, Kampala, Uganda.
  • Mudiope P; Ministry of Health, Kampala, Uganda.
  • Glick S; Ministry of Health, Kampala, Uganda.
  • Lambdin B; Department of Medicine, University of Washington, Seattle, USA.
  • Mujugira A; Department of Global Health, University of Washington, 3980 15th Ave NE, Box 351620, Seattle, WA, 98195, USA.
  • Heffron R; Research Triangle Institute, Berkeley, USA.
Addict Sci Clin Pract ; 19(1): 13, 2024 02 23.
Article em En | MEDLINE | ID: mdl-38395940
ABSTRACT

BACKGROUND:

People who inject drugs (PWID) are at increased risk of HIV acquisition and often encounter barriers to accessing healthcare services. Uganda has high HIV prevalence among PWID and lacks integrated pre-exposure prophylaxis (PrEP) and harm reduction services. Understanding PWID experiences accessing and using harm reduction services and PrEP will inform strategies to optimize integration that align with PWID needs and priorities.

METHODS:

Between May 2021 and March 2023, we conducted semi-structured interviews with PWID in Kampala, Uganda. We recruited participants with and without previous experience accessing harm reduction services and/or PrEP using purposive and snowball sampling. Interviews were audio recorded, translated, and transcribed. We used thematic analysis to characterize motivations for uptake of harm reduction and HIV prevention services, and strategies to optimize delivery of needle and syringe programs (NSP), medications for opioid use disorder (MOUD), and PrEP.

RESULTS:

We conducted interviews with 41 PWID. Most participants were relatively aware of their personal HIV risk and accurately identified situations that increased risk, including sharing needles and engaging in transactional sex. Despite risk awareness, participants described engaging in known HIV risk behaviors to satisfy immediate drug use needs. All reported knowledge of harm reduction services, especially distribution of sterile needles and syringes, and many reported having experience with MOUD. Participants who had accessed MOUD followed two primary trajectories; limited resources and relationships with other PWID caused them to discontinue treatment while desire to regain something they believed was lost to their drug use motivated them to continue. Overall, PrEP knowledge among participants was limited and few reported ever taking PrEP. However, participants supported integrating PrEP into harm reduction service delivery and advocated for changes in how these services are accessed. Stigma experienced in healthcare facilities and challenges acquiring money for transportation presented barriers to accessing current facility-based harm reduction and HIV prevention services.

CONCLUSIONS:

Meeting the HIV prevention needs of PWID in Uganda will require lowering barriers to access, including integrated delivery of PrEP and harm reduction services and bringing services directly to communities. Additional training in providing patient-centered care for healthcare providers may improve uptake of facility-based services.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Infecções por HIV / Abuso de Substâncias por Via Intravenosa / Síndrome da Imunodeficiência Adquirida / Usuários de Drogas / Transtornos Relacionados ao Uso de Opioides Limite: Humans País/Região como assunto: Africa Idioma: En Revista: Addict Sci Clin Pract Assunto da revista: TRANSTORNOS RELACIONADOS COM SUBSTANCIAS Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Uganda

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Infecções por HIV / Abuso de Substâncias por Via Intravenosa / Síndrome da Imunodeficiência Adquirida / Usuários de Drogas / Transtornos Relacionados ao Uso de Opioides Limite: Humans País/Região como assunto: Africa Idioma: En Revista: Addict Sci Clin Pract Assunto da revista: TRANSTORNOS RELACIONADOS COM SUBSTANCIAS Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Uganda