Background:
Opioid substitution therapy (OST) is highly effective for opioid dependence, reducing harm and supporting treatments like HIV, HCV and tuberculosis care. However, OST accessibility is limited by stigma, discriminatory practices, policy implementation gaps, geographic and economic barriers. Effective outreach, comprehensive services, and peer support are crucial for improving access and retention. A process evaluation assessed factors influencing the accessibility, uptake, and retention of OST through a community-based harm reduction program (2019-2024).
Methods:
A mixed-methods approach (surveys, interviews, focus groups) evaluate the OST component of the NACOSA harm reduction program in 5 districts in South Africa for people who use drugs. It used quota sampling for diverse representation and analyzed qualitative data thematically and quantitative data descriptively.
Results:
The evaluation surveyed 326 current and 39 former OST beneficiaries. Focus groups engaged 85 beneficiaries. Surveys included 60 peers and 35 support-persons. 80 Implementing staff members participated in surveys and interviews. OST program accessibility is primarily enabled by peer educators (91.4%, n=298) and community engagement (76.5%, n=91), with beneficiaries citing peer support as crucial. However, barriers include resource constraints (36.1%, n=43), policy limitations (12.6%, n=15), and community resistance (31.9%, n=38). OST uptake is influenced by personal motivation (51.3%, n=61), social support (70.6%, n=84), and accessible services (58.0%, n=69), but this can be hindered by social determinants such as a lack of housing (46.2%, n=55). Retention is enabled by peer support (91.4%, n=298 relationship with peers; 90.8%, n=300 regular peer contact; 96.6%, n=315 ease of staying on OST), staff reliability (96.3%, n=314), and family involvement (72.3%, n=86). Barriers to retention include OST side effects (20.6%, n=79), lack of transport (38.3%, n=147), and competing priorities (9.1%, n=35).
Conclusion:
This evaluation highlights the critical role of peer support and community engagement in OST program success, while addressing barriers like stigma and resource constraints. |