Is the promise of methadone Kenya’s solution to managing HIV and addiction? A mixed-method mathematical modelling and qualitative study

摘要: Background and objectives Promoted globally as an evidence-based intervention in the prevention of HIV treatment heroin addiction among people who inject drugs (PWID), opioid substitution (OST) can help control emerging epidemics PWID. With implementation December 2014, Kenya is third Sub-Saharan African country to have introduced OST. We combine dynamic mathematical modelling with qualitative sociological research examine ‘promise methadone’ Kenya. Methods, setting participants model impact OST Nairobi, Kenya, at different levels coverage. draw on thematic analyses 109 interviews PWID, 43 stakeholders, chart their narratives expectation relation promise methadone. Results The modelled shows relatively slight reductions incidence (5–10%) prevalence (2–4%) over 5 years coverage (around 10%) anticipated planned roll-out However, there a higher increased coverage, 40% producing 20% reduction incidence, even when accounting for high sexual transmissions. Qualitative findings emphasise culture ‘rationed expectation’ access care ‘poverty drug opportunity’. In this context, methadone may be narrated symbol hope—both individuals community—in recovery. Conclusions Methadone offers potential, but need better effects transmission mediating PWID settings characterised by combination generalised concentrated epidemics. find that individual community hope recovery coexist policy positioning primarily prevention. Our show value mixed methods approaches investigating newly-introduced interventions.