Economic, social, and clinic influences on opioid treatment program retention in Dar es Salaam, Tanzania: a qualitative study.
Economic, social, and clinic influences on opioid treatment program retention in Dar es Salaam, Tanzania: a qualitative study.
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DOI：
10.1186/s13722-023-00374-1
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发表时间：
2023-03-27
影响因子：
3.7
通讯作者：
Saleem, Haneefa T.
中科院分区：
文献类型：
--
作者：
Knight, Deja;Nkya, Iddi Haruna;West, Nora Solon;Yang, Cui;Kidorf, Michael;Latkin, Carl;Saleem, Haneefa T.
治疗阿片使用障碍(Moud)的药物与积极的健康结果有关。继续服用Moud的人服药过量和死亡的可能性降低。坦桑尼亚支持提供Moud的国家阿片类药物治疗计划(OTP)，但保留是一个持续的挑战。到目前为止，坦桑尼亚和其他撒哈拉以南非洲地区关于Moud保留的研究大多集中在个人层面，很少关注经济、社会和临床层面的因素。我们定性地检查了在坦桑尼亚达累斯萨拉姆OTP诊所就诊的前任和现任客户中影响Moud滞留的经济、社会和临床因素，特别是美沙酮维持疗法。在2020年1月至4月期间，我们对总共40名接受Moud的现任和前任客户以及4个焦点小组进行了深入访谈，并在Moud上增加了35名现任客户。我们使用了主题分析方法。每天去OTP诊所就诊给现任和前任客户带来了经济负担，也是继续留在Moud的障碍。虽然治疗是免费的，但据客户描述，他们很难去诊所就诊，包括负担得起交通费。女性客户受到的影响不同，因为性工作是她们参与的最常见的创收活动，这带来了一系列独特的挑战，包括在固定的诊所时间就诊的障碍。吸毒污名是Moud的障碍，阻止客户找到工作，在社区内重建信任，以及使用交通工具去诊所就诊。能够与家人重建信任有助于留在穆德，因为家人提供了社会和财政支持。女性客户的照顾责任和家庭期望与穆德的坚守相冲突。最后，诊所层面的因素，如诊所配药时间和违反规定的惩罚性后果，对Moud上的客户构成了障碍。社会和结构性因素，包括诊所内部(例如，临床政策)和外部(例如，交通)，都会影响Moud的保留。我们的发现可以为解决穆德面临的经济和社会障碍的干预措施和政策提供参考，这也有助于持续的复苏。
Medications for opioid use disorder (MOUD) are associated with positive health outcomes. People remaining on MOUD have a reduced likelihood of drug overdose and mortality. Tanzania supports a national opioid treatment program (OTP) offering MOUD, but retention is a continual challenge. To date, most research on MOUD retention in Tanzania and other Sub-Saharan Africa settings has been focused on the individual-level, with little attention to economic, social, and clinic-level factors. We qualitatively examined economic, social, and clinic factors that affect retention on MOUD, specifically methadone maintenance therapy, among former and current clients attending an OTP clinic Dar es Salaam, Tanzania. We conducted in-depth interviews with a total of 40 current and former clients receiving MOUD and four focus groups with an additional 35 current clients on MOUD between January and April 2020. We utilized a thematic analysis approach. Daily OTP clinic attendance posed a financial burden to current and former clients and was a barrier to remaining on MOUD. Though treatment is free, clients described struggles to attend clinic, including being able to afford transportation. Female clients were differentially impacted, as sex work was the most common income-generating activity that they participated in, which presented its own set of unique challenges, including barriers to attending during set clinic hours. Drug use stigma acted as a barrier to MOUD and prevented clients from securing a job, rebuilding trust within the community, and accessing transportation to attend the clinic. Being able to rebuild trust with family facilitated remaining on MOUD, as family provided social and financial support. Caretaking responsibilities and familial expectations among female clients conflicted with MOUD adherence. Finally, clinic level factors, such as clinic dispensing hours and punitive consequences for breaking rules, posed barriers to clients on MOUD. Social and structural factors, both within (e.g., clinic policies) and outside of (e.g., transportation) the clinic impact MOUD retention. Our findings can inform interventions and policies to address economic and social barriers to MOUD, that can contribute to sustained recovery.
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影响因子：
4.4
作者：
Flickinger TE;DeBolt C;Xie A;Kosmacki A;Grabowski M;Waldman AL;Reynolds G;Conaway M;Cohn WF;Ingersoll K;Dillingham R
通讯作者：
Dillingham R
DOI：
10.1192/pb.bp.108.020925
发表时间：
2009-06-01
期刊：
PSYCHIATRIC BULLETIN
影响因子：
--
作者：
Luty, Jason;Umoh, Okon;Nuamah, Francis
通讯作者：
Nuamah, Francis
影响因子：
3.9
作者：
Abadie R;McLean K;Habecker P;Dombrowski K
通讯作者：
Dombrowski K
影响因子：
4.4
作者：
Hayashi, Kanna;Ti, Lianping;Kerr, Thomas
通讯作者：
Kerr, Thomas
影响因子：
11.8
作者：
Lambdin, Barrot H.;Masao, Frank;Bruce, R. Douglas
通讯作者：
Bruce, R. Douglas