Télécharger Format PDF 2,41 Mio Assessment of risk practices and infectious disease among drug users in Tanzania

Prepared by the Centre for Population Health, Burnet Institute for Médecins du Monde – France

Dr Joseph Mbatia, Ministry of Health and Social Welfare – Tanzania; Sandrine Pont, Dr Fatima Asouab

Issue: Recent research has documented the increasing prevalence of injecting drug use in Eastern Africa. It is estimated that at least 25.000 IDUs live Tanzania.  Resaerch has shown as well a high HIV prevalence among this population – about 40% among IDUs in Dar-es-Salaam, Tanzania, with female IDUs having prevalence rates of around 60%. A recent Rapid Assessment and Response (RAR) conducted by MdM showed an overall HIV prevalence of 36% among PWID (67% for female PWID). Overall HCV prevalence was 28% and coinfection was 15% among men and 28% among women.

Temeke is the poorest of the three urban Districts of Dar-es-Salaam and drug use is rather visible and widespread in the community.

Nevertheless, access to comprehensive and effective harm reduction services remains very difficult for drug users in Tanzania as well as regionally. Harm reduction services, including needle exchange programming, opiate substitution therapy (OST) and acess to HIV care and treatment services are essential in reducing HIV transmission as well as other health and social risks.  

Description: The Ministry of Health and Social Welfare in cooperation with Temeke Council and the International Non-Governmental Medical Organisation Médecins du Monde France (MdM-F) have started a comprehensive Harm Reduction intervention in Temeke District and providing sterile injection material since March 2011. This program is mainly targeting IDUs.

The program includes access to basic health care and social services, HIV and HCV testing as well as  provision of sterile injection material and behaviour change communication in a drop-in centre,and through outreach activities. Moreover, the program includes community information and a peer support component. Users are encouraged to keep injection material in safety boxes and to return it, in order to start cleaning the injection sites. Special attention is given to female users who are strongly stigmatized and at even higher risk of HIV infection through concomitant sex work.

As of October 2011, MdM has reached 1645 beneficiaries, among which 1485 IDU since the start of its operation. Around 45 IDUs are attending the drop-in centre every day, and during outreach activities an average of 50 IDUs are reached. The female IDUs are more hidden and rather difficult to approach, but the introduction of a specific day dedicated to women IDUs in the drop-in centre has helped to reach 15 of them on a regular basis. An average of 400 sterile kits (with 20 syringes per kit) per week is distributed to IDUs (including syringes, sterile water, alcohol swabs and condoms).

Lessons learned:

Several months after starting the provision of sterile equipment, condoms and safe injection messages, first changes in IDUs’ behaviour have been noticed. Sterile material is used by the IDUs as soon as they can get free access. Community acceptance was high towards the program, thanks partly to awareness raising through workshops, an open day in the drop in center, and attending community development committees meetings. Needle exchange programming seems thus clearly feasible and acceptable in a semi-urban African context.

Next steps: Significant challenges remain at the policy level, especially regarding needle exchange programming and in the provision of antiretroviral therapy (ART) as well as opiate substitution therapy (OST) to this population. A Methadone treatment pilot project started at Muhimbili in 2011. The MoH awaits the results before deciding on scaling up MAT to other districts of Tanzania but discussions and preparations are under way.

The programme will continue focusing on capacity building of national stakeholders through training, study tours, and international conferences.

^{novembre 2011}

novembre 2011