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Implementation Science in HIV Related Work: Case Study of Injection Drug Users Intervention in...

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Jessie Mbwambo, Muhimbili National Hospital (MNH) and Muhimbili University of Health and Allied Sciences (MUHAS
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Jessie Mbwambo, Jessie Mbwambo, Muhimbili National Muhimbili National Hospital (MNH) and Muhimbili Hospital (MNH) and Muhimbili University of Health and Allied University of Health and Allied Sciences (MUHAS) Sciences (MUHAS)
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Page 1: Implementation Science in HIV Related Work: Case Study of Injection Drug Users Intervention in Tanzania

Jessie Mbwambo, Jessie Mbwambo, Muhimbili Muhimbili National Hospital (MNH) and National Hospital (MNH) and

Muhimbili University of Health and Muhimbili University of Health and Allied Sciences (MUHAS)Allied Sciences (MUHAS)

Page 2: Implementation Science in HIV Related Work: Case Study of Injection Drug Users Intervention in Tanzania

What is Implementation Sciences

What is the value of Implementation Science

Background to the Injection Drug Use in the region

Implementation science for injection drug users—The case study of a methadone treatment program

Research questions for Implementation Sciences for Injection Drug Users

Presentation format

Page 3: Implementation Science in HIV Related Work: Case Study of Injection Drug Users Intervention in Tanzania

IS is the study of approaches to translate

effective interventions into health care policy and practice.

IS draws from a variety of different research disciplines including epidemiology, biostatistics, anthropology, sociology, health policy, health economics, management sciences, mathematical modeling, community engagement and ethics.

Using these methodologies with HIV programs, IS identifies, develops and measures the impact of innovative strategies to improve HIV service delivery, thereby strengthening the global AIDS response.

Definition of Implementation Sciences

(IS)

Page 4: Implementation Science in HIV Related Work: Case Study of Injection Drug Users Intervention in Tanzania

Framework for IS

Page 5: Implementation Science in HIV Related Work: Case Study of Injection Drug Users Intervention in Tanzania

IS Framework 1

To begin addressing IS questions, a clear understanding of the gaps in HIV for KP programs must be developed.

Establish and strengthen M&E and surveillance systems that facilitate identification of bottlenecks, gaps and missed opportunities in KP program delivery .

Page 6: Implementation Science in HIV Related Work: Case Study of Injection Drug Users Intervention in Tanzania

IS Framework 2

Effective translation of evidence into practice via relationships and activities between communities that facilitate the delivery of health services and health interventions

Page 7: Implementation Science in HIV Related Work: Case Study of Injection Drug Users Intervention in Tanzania

Deciding where change(s) must be targeted

among the components of health care system and what are the best approaches for inducing change, whether organizational, social or individual levels.

Formulating new approaches where teams should consider the context of the linkages, interactions, relationships and behaviors of the components of the system of health care under investigation .

Development of strategies and approaches that can be translated to other settings allowing for local adaptation as appropriate.

IS Framework#2

Page 8: Implementation Science in HIV Related Work: Case Study of Injection Drug Users Intervention in Tanzania

IS Framework 3

Engaging researchers who have experience in developing studies to answer IS questions critical

Research personelle to be familiar to using multiple methodologies to answer questions

Using cost data and analysis of data to understand the relative efficiency of different approaches by measuring and comparing the costs and consequences of different strategies.

Page 9: Implementation Science in HIV Related Work: Case Study of Injection Drug Users Intervention in Tanzania

IS Framework 4

Success of IS initiatives is when research findings are used to improve programs and tailor policies when lessons have been learned.

IS initiatives should include a plan for how to achieve this with understanding that the approach will change along the way.

Considerations of how to address a programmatic gap or measure that impact the new strategy

Page 10: Implementation Science in HIV Related Work: Case Study of Injection Drug Users Intervention in Tanzania

Approaches used to accomplish these

goals will vary from situation to situation.

understanding what ways the results from a particular initiative should be utilized – including polices at a national, regional or global level is critical

strategic planning within service delivery systems (i.e., clinics or hospitals) or program strategies among community-based organizations – should also be understood.

IS framework 4……….

Page 11: Implementation Science in HIV Related Work: Case Study of Injection Drug Users Intervention in Tanzania

Value of Implementation

Science

Page 12: Implementation Science in HIV Related Work: Case Study of Injection Drug Users Intervention in Tanzania
Page 13: Implementation Science in HIV Related Work: Case Study of Injection Drug Users Intervention in Tanzania

Globally 151 countries have reported presence of Injection Drug Use

15.9 million people inject drugs 3million of those are HIV infected No population estimates in many

countries of SSA HIV reported in many small scale studies In Tanzania using snow ball format rates

between 42-51% among PWID Constellation of multiple risky

behaviours possibly crossing into general reported in Kenya, cannot be different elsewhere

Injecting drug users and HIV

Page 14: Implementation Science in HIV Related Work: Case Study of Injection Drug Users Intervention in Tanzania

Program entitled “Reducing

HIV/AIDS transmission in people who inject drugs their sexual and injecting networks in Dar es Salaam, Tanzania”

Started 2009 through Cooperative Agreement to MUHAS from CDC with funding from the PEPFAR

Prevention of HIV among PWIDS in Dar es

Salaam

Page 15: Implementation Science in HIV Related Work: Case Study of Injection Drug Users Intervention in Tanzania

TAPP at the forefront of efforts in sub-Saharan Africa to address HIV transmission among people who inject drugs and their social networks.

Used a combination approach to HIV prevention for PWIDs TAPP created an outreach program with

Tanzanian non-governmental organizations (NGOs) that uses a variety of community-based, clinical and state level interventions to address different levels of vulnerability

Prevention#2

Page 16: Implementation Science in HIV Related Work: Case Study of Injection Drug Users Intervention in Tanzania

Injection drug users programing at MUHAS

Page 17: Implementation Science in HIV Related Work: Case Study of Injection Drug Users Intervention in Tanzania

Used program data to raise

questions: TB screening and diagnosis: Active Case Finding for

Tuberculosis among People Who Inject Drugs on Methadone Treatment in Dar es Salaam, Tanzania

Where do we loose women in the cascade to MAT: Understanding Barriers to Methadone Assisted Therapy Among Female Heroin Users in Dar es Salaam, Tanzania

Who are the defaulters when using methadone: Methadone Dose, Age and History of Abuse Impact Clients’ Risk of Defaulting from Methadone Treatment in Dar es Salaam, Tanzania

Identify programmatic gaps

Page 18: Implementation Science in HIV Related Work: Case Study of Injection Drug Users Intervention in Tanzania

Inequities in health care delivery: Methadone

Treatment for HIV Prevention-Feasibility, Retention and Predictors of Defaulting in Dar es Salaam, Tanzania: A Retrospective Cohort Study

What is the quality of life of those on methadone: Quality of life among people who inject drugs attending Muhimbili Methadone Clinic in Dar-es-Salaam

How to maximize utilization at MAT to prevent HIV: Providing Medication Assisted Treatment (MAT) as an HIV Prevention Intervention: Programmatic Strategies to Maximize Service Utilization in Dar es Salaam, Tanzania

Identifying program gaps 2

Page 19: Implementation Science in HIV Related Work: Case Study of Injection Drug Users Intervention in Tanzania

TB screening and diagnosis: Use

GeneXpert gives real time results can even work with low quantity of microbes in sputum and results within short time

Where do we loose women in the cascade to MAT: Night time community out reach work and economic empowerment

Who are the defaulters when using methadone: Young people give “older peers” as treatment supporters; people on low doses have doses increased

Developing and implementing strategies

Page 20: Implementation Science in HIV Related Work: Case Study of Injection Drug Users Intervention in Tanzania

IS 3: Measuring effectiveness

and efficiency Young program not yet there

IS 4: Utilizing information Young program not yet there

IS 3 and IS 4

Page 21: Implementation Science in HIV Related Work: Case Study of Injection Drug Users Intervention in Tanzania
Page 22: Implementation Science in HIV Related Work: Case Study of Injection Drug Users Intervention in Tanzania

Research Gaps

Integrated Bio Behavioural Surveys (IBBS) needed to have a denominator for the 50% needed for interventions done to make it possible for turning the tide of the HIV epidemic among PWIDs

What cadres and quantities of human resource for health are required for implementing comprehensive services for PWIDs

Evaluation of interventions as is outlined a main option Pre and post test utilization designs (depends on

corrections of previous observations) Mental and social outcomes for PWIDS in and not

in treatment


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