Access to Opioid Substitution Therapy for the Incarcerated People Who Use Drugs in Kiambu County, Kenya.


Author: Angela Thiongo, Rahab Nina, Richard Muiruri, Tolbert Ayuaya, Brian Hove, Janet Ngethe, Tom Ellman

Theme: Epidemiology & Public Health Research Year: 2023

Background:
It was estimated that 26,673 people use opioids in Kenya by 2021, with 3,312 of them in Kiambu County. In September 2019, Médecins Sans Frontiers (MSF) in partnership with Kiambu County Government started a People Who Use Drugs (PWUD) Project. The criminalization of drug use has resulted in a substantial proportion of PWUDs becoming subject to police brutality, and incarceration. In October 2021 MSF started providing Medically Assisted Therapy (MAT) to incarcerated drug users in collaboration with Kenya Prisons.

Description of model of care/intervention:
With the increasing number of incarcerated patients on MAT, MSF in collaboration with Kenya Prison provides access to MAT and viral hepatitis C treatment to incarcerated patients as a differentiated service delivery model. MSF supports the mapping of patients in prison through patient tracking and training of prison officers to dispense prepacked doses and management of withdrawals and overdoses.

Effectiveness:
By February 2023, 148 incarcerated patients had received daily dose of opioid substitution therapy in four government prisons, 139 on methadone and 9 on Buprenorphine, 17percent of ever enrolled MAT clients. This has improved access to MAT, medical care, sustained hepatitis C treatment, enhanced adherence and decreased recidivism. Other services include psychosocial and paralegal support hence improving the quality of care for the incarcerated PWUD on MAT.

Conclusion and next steps:
An improved criminal justice system and increased collaboration between prison and public health systems can lead to substantial positive treatment outcomes for incarcerated PWUDs. The provision of MAT for incarcerated PWUDs highlights the right to medical access and is consistent with patient rights and advocacy.

Disclosure of Interest Statement:
MSF funds the Kiambu PWUD Project. For all the authors, no conflict of interest has been identified.

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