the access to care study in kenya: pwid experiences of care and the risk environment
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Supporting community action on HIV & AIDs and TB
The Access to Care Study in Kenya: PWID experiences of care and the risk
environmentNOPE Conference
Prof Tim Rhodes; LSHTM Sylvia Ayon, KANCO; Dr Andy Guise, LSHTM James Ndimbii, KANCO; Dr
Sobbie Mulindi, NACCwith and the Access2Care Outreach project
partners – Omari Project, Teenswatch, NOSET
Friday 20th June 2014
Supporting community action on HIV & AIDs and TB
The A2C study
Context Est 18,327 PWID, est HIV
prevalence 18.3% (44.5% for women)
Introduction of harm reduction services – needle and syringe exchange
Study aim – understand the risk environment
Understand impact of new services, and experience of PWID, to support ongoing development of harm reduction services
Supporting community action on HIV & AIDs and TB
A2C study: methodology
Three sites – Malindi (Omari Project), Ukunda (Teenswatch), Nairobi (NOSET)
Qualitative: In-depth interviews with PWID, observation, stakeholder interviews
Longitudinal: 4 waves of data collection, ongoing
Baseline 6 mths 12 mths 24 mths
NAIROBI PWID: N=30 PWID: N=12 PWID: N=12 PWID: N=12
Stakeholders: N=7
Stakeholders: N=7
MALINDI PWID: N=50 PWID: N=16 PWID: N=16 PWID: N=16
Stakeholders: N=7
Stakeholders: N=7
UKUNDA PWID: N=30 PWID: N = 5 PWID:N = 5 PWID: N = 5
Stakeholders: N=7
Stakeholders: N=7
Supporting community action on HIV & AIDs and TB
Qualitative perspectives on harm reduction and HIV in
Kenya
The role of qualitative researchEngage with change and
dynamismAccessing detail of
experienceUnderstanding local
processes and adaption Identify pathways from
structure to individual
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Emerging themes in analysis
Changes in Sharing following NSP
Access to HIV care for PWID
Drug Treatment
Changes in the HIV and harm reduction policy environment
Effective Government policy
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Syringe sharing in the context of harm
reduction Pre-NSP
Accessing injecting equipment-challenges Sharing-inevitable, normative and acceptable
Reflections on NSP The gains, perceptions and challenges Sharing avoidable, rather than inevitable Sharing becomes situational
Priorities How to improve and maximize
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Syringe sharing – pre-NSP
Wave 1 interviews conducted just before implementation of NSP
Massive accounts of sharing
Limited access to needles and syringes-restricted sale by retail outlets, costs, places of access versus using sites and legal environment
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Reflections on NSP
Outreach and DIC based NSP Improved access to needles
and syringes Decline in accounts of
sharing Heightened awareness in
relation to sharing risks-outreach-led NSP
Social facilitators enhancing post NSP sharing
Supporting community action on HIV & AIDs and TB
Context for continued sharing
HIV Status
Costs of accessing NSP
Withdrawal
Social/intimate relationships among PWID
Supporting community action on HIV & AIDs and TB
Implications and social interventions
Specific contextual factors play a significant role in enhancing sharing, and go beyond availing needles and syringes
How can current interventions be constructed to cater for these specific contexts? Weekend delivery, linking to pharmacies? Targeted messaging for PLHIV? Links to HIV care?
Supporting community action on HIV & AIDs and TB
Asante Sana – Thank you