ArticleThe International journal on drug policy2016
"Can't you initiate me here?": Challenges to timely initiation on antiretroviral therapy among methadone clients in Dar es Salaam, Tanzania.
Article in The International journal on drug policy, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.
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Who cites it
18 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Being HIV positive and staying on antiretroviral therapy in Africa: A qualitative systematic review and theoretical model.PloS one · 2019Pooled it
- Feasibility, Acceptability, and Preliminary Efficacy of a Pilot Study To Integrate Buprenorphine into a Harm-reduction Drop-in-Center in Kampala, Uganda.AIDS and behavior · 2026Article
- Family Perspectives on Stigma Toward Women Who Use Drugs in Tanzania.Issues in mental health nursing · 2025Article
- Psychometric performance of tools to measure internalized drug use stigma among people who use drugs and people on medication-assisted treatment in Dar es Salaam, Tanzania.Drug and alcohol dependence · 2024Article
- Adverse Childhood Experiences and HIV-Related Stigma: A Quantitative Survey of Tanzanian Men, June 2019.AIDS and behavior · 2024Article
- Adapting a health facility HIV stigma-reduction participatory training intervention to address drug use stigma in HIV care and treatment clinics in Dar es Salaam, Tanzania.Harm reduction journal · 2024Article
- Prevalence and predictors of depressive and anxiety symptoms in a sample of women who use drugs in Tanzania: the key role of drug use stigma.BMC psychiatry · 2023Article
- Economic, social, and clinic influences on opioid treatment program retention in Dar es Salaam, Tanzania: a qualitative study.Addiction science & clinical practice · 2023Article
- Translation and cultural adaptation of drug use stigma and HIV stigma measures among people who use drugs in Tanzania.PloS one · 2023Article
- The Role of Context in Integrating Buprenorphine into a Drop-In Center in Kampala, Uganda, Using the Consolidated Framework for Implementation Research.International journal of environmental research and public health · 2022Article
- Participation in methadone programs improves antiretroviral uptake and HIV viral suppression among people who inject drugs in Kenya.Journal of substance abuse treatment · 2022Article
- Time-space constraints to HIV treatment engagement among women who use heroin in Dar es Salaam, Tanzania: A time geography perspective.Social science & medicine (1982) · 2021Article
- Time to Treatment Initiation and Retrospective Analysis of Antiretroviral Therapy Outcomes among HIV-positive Methadone Maintenance Therapy Clients in Primary Health-care Centers, Kuantan, Pahang.Journal of pharmacy & bioallied sciences · 2020Article
- Integrated and differentiated methadone and HIV care for people who use drugs: a qualitative study in Kenya with implications for implementation science.Health policy and planning · 2019Article
- Evaluating the Integrated Methadone and Anti-Retroviral Therapy Strategy in Tanzania Using the RE-AIM Framework.International journal of environmental research and public health · 2019Article
- Patient and provider perspectives on implementation barriers and facilitators of an integrated opioid treatment and HIV care intervention.Addiction science & clinical practice · 2019Article
- Convenience without disclosure: a formative research study of a proposed integrated methadone and antiretroviral therapy service delivery model in Dar es Salaam, Tanzania.Addiction science & clinical practice · 2017Article
- Improving linkage to HIV care at low-threshold STI/HIV testing sites: An evaluation of the Immediate Staging Pilot Project in Vancouver, British Columbia.Canadian journal of public health = Revue canadienne de sante publique · 2017Article
Corrections and comments
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Authors and funding
7 authors.
Funding
Abstract
backgroundDespite dramatic improvement in antiretroviral therapy (ART) access globally, people living with HIV who inject drugs continue to face barriers that limit their access to treatment. This paper explores barriers and facilitators to ART initiation among clients attending a methadone clinic in Dar es Salaam, Tanzania.
methodsWe interviewed 12 providers and 20 clients living with HIV at the Muhimbili National Hospital methadone clinic between January and February 2015. We purposively sampled clients based on sex and ART status and providers based on job function. To analyze interview transcripts, we adopted a content analysis approach.
resultsParticipants identified several factors that hindered timely ART initiation for clients at the methadone clinic. These included delays in CD4 testing and receiving CD4 test results; off-site HIV clinics; stigma operating at the individual, social and institutional levels; insufficient knowledge of the benefits of early ART initiation among clients; treatment breakdown at the clinic level possibly due to limited staff; and initiating ART only once one feels physically ill. Participants perceived social support as a buffer against stigma and facilitator of HIV treatment. Some clients also reported that persistent monitoring and follow-up on their HIV care and treatment by methadone clinic providers led them to initiate ART.
conclusionHealth system factors, stigma and limited social support pose challenges for methadone clients living with HIV to initiate ART. Our findings suggest that on-site point-of-care CD4 testing, a peer support system, and trained HIV treatment specialists who are able to counsel HIV-positive clients and initiate them on ART at the methadone clinic could help reduce barriers to timely ART initiation for methadone clients.
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