Awareness of drug supply changes and uptake of fentanyl testing services among people who use drugs in Kampala, Uganda.

Synthetic opioids, such as fentanyl, are appearing in the heroin supply in some regions of the world. Fentanyl test strips are an important overdose prevention strategy. However, these services in Africa have been limited, leaving uncertainty about the extent of fentanyl's presence in the drug supply. This cross-sectional study evaluated awareness of drug supply changes and the uptake of fentanyl testing among people who use drugs enrolled in an HIV pre-exposure prophylaxis program in Kampala, Uganda. In 2023-2024, people receiving syringe services or methadone treatment were surveyed and invited to bring drug residue samples to be tested with fentanyl test strips. Descriptive statistics and logistic regression were used to examine correlates. Among 110 survey participants,18 % had recently experienced an overdose, 26 % had heard of fentanyl, and 8 % had knowingly used it. Among the 78 people offered fentanyl testing, 81 % returned with a drug sample for testing. Syringe services participants and people with better transportation access were more likely to return for the testing opportunity. Of 68 samples tested, 46 % were suspected by participants to be cocaine and 40 % street opioids. All but one sample tested negative for fentanyl. All expressed willingness to participate in future testing and would recommend it to others. While fentanyl was not widely detected, high interest among study participants shows its promise as an overdose prevention strategy among people who use drugs. Expanding these services could be beneficial, particularly through community distribution via syringe services programs, and broadening access to novel drug supply additives.