Integrated and differentiated methadone and HIV care for people who use drugs: a qualitative study in Kenya with implications for implementation science.
Integrating methadone and HIV care is a priority in many low- and middle-income settings experiencing a growing challenge of HIV epidemics linked to injecting drug use. There is as yet little understanding of how to integrate methadone and HIV care in these settings and how such services can be impl...
| Publicado en: | Health Policy & Planning Vol. 34; no. 2; pp. 110 - 120 |
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| Autores principales: | , , , , , |
| Formato: | Journal Article |
| Publicado: |
Oxford University Press / USA
Mar2019
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=136101865&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 136101865 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 02681080 N5E jtl: Health Policy & Planning issn: 02681080 maglogo: N pubinfo: dt: Mar2019 vid: 34 iid: 2 pid: 622 pub: Oxford University Press / USA artinfo: ui: 136101865 136101865 NLM30789208 10.1093/heapol/czz002 NLM30789208 136101865 ppf: 110 ppct: 10 formats: tig: atl: Integrated and differentiated methadone and HIV care for people who use drugs: a qualitative study in Kenya with implications for implementation science. aug: au: Guise, Andy Ndimbii, James Igonya, Emmy Kageha Owiti, Frederick Strathdee, Steffanie A Rhodes, Tim affil: Department of Medicine, University of California San Diego, San Diego, 9500 Gilman Drive, La Jolla, CA, USA School of Population Health and Environmental Sciences, King's College London, London, UK sug: subj: Methadone Administration and Dosage HIV Infections Drug Therapy Anti-Retroviral Agents Administration and Dosage Kenya Qualitative Studies Adult Substance Abuse, Intravenous Drug Therapy Female Attitude of Health Personnel Health Care Delivery, Integrated Methods Male Stigma Middle Age Adult: 19-44 years Middle Aged: 45-64 years Female Male ab: Integrating methadone and HIV care is a priority in many low- and middle-income settings experiencing a growing challenge of HIV epidemics linked to injecting drug use. There is as yet little understanding of how to integrate methadone and HIV care in these settings and how such services can be implemented; such a gap reflects, in part, limitations in theorizing an implementation science of integrated care. In response, we qualitatively explored the delivery of methadone after its introduction in Kenya to understand integration with HIV care. Semi-structured interviews with people using methadone (n = 30) were supplemented by stakeholder interviews (n = 2) and participant observation in one city. Thematic analysis was used, that also drew on Mol's logic of care as an analytical framework. Respondents described methadone clinic-based care embedded in community support systems. Daily observed clinic care was challenging for methadone and stigmatizing for HIV treatment. In response to these challenges, integration evolved and HIV care differentiated to other sites. The resulting care system was acceptable to respondents and allowed for choice over locations and approaches to HIV care. Using Mol's logic of care as an analytical framework, we explore what led to this differentiation in integrated care. We explore co-production and experimentation around HIV care that compares with more limited experimentation for methadone. This experimentation is bounded by available discourses and materials. The study supports continued integration of services whilst allowing for differentiation of these models to adapt to client preferences. Co-location of integrated services must prioritize clinic organization that prevents HIV status disclosure. Our analysis fosters a material perspective for theory of implementation science and integration of services that focuses attention on local experimentation shaped by context. pubtype: Academic Journal doctype: Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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