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

Author

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  • Saria Hassan

    (Yale School of Medicine, Yale University, New Haven, CT 06511, USA)

  • Alexis Cooke

    (San Francisco Department of Psychiatry, University of California, San Francisco, CA 94118, USA)

  • Haneefa Saleem

    (Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA)

  • Dorothy Mushi

    (Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar-Es-Salaam 11000, Tanzania)

  • Jessie Mbwambo

    (Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar-Es-Salaam 11000, Tanzania)

  • Barrot H. Lambdin

    (RTI International, San Francisco, CA 94104, USA)

Abstract

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.

Suggested Citation

  • Saria Hassan & Alexis Cooke & Haneefa Saleem & Dorothy Mushi & Jessie Mbwambo & Barrot H. Lambdin, 2019. "Evaluating the Integrated Methadone and Anti-Retroviral Therapy Strategy in Tanzania Using the RE-AIM Framework," IJERPH, MDPI, vol. 16(5), pages 1-15, February.
    • Handle: RePEc:gam:jijerp:v:16:y:2019:i:5:p:728-:d:209827
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    References listed on IDEAS

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    1. Glasgow, R.E. & Vogt, T.M. & Boles, S.M., 1999. "Evaluating the public health impact of health promotion interventions: The RE-AIM framework," American Journal of Public Health, American Public Health Association, vol. 89(9), pages 1322-1327.
    2. Mullen, Patricia D. & Hersey, James C. & Iverson, Donald C., 1987. "Health behavior models compared," Social Science & Medicine, Elsevier, vol. 24(11), pages 973-981, January.
    3. Glasgow, R.E. & Lichtenstein, E. & Marcus, A.C., 2003. "Why Don't We See More Translation of Health Promotion Research to Practice? Rethinking the Efficacy-to-Effectiveness Transition," American Journal of Public Health, American Public Health Association, vol. 93(8), pages 1261-1267.
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