Individual and structural benefits, challenges, and strategies for integrating medication assistance treatment and antiretroviral services for persons living with HIV who use drugs in Dar es Salaam, Tanzania

Background: People who use drugs (PWUDs) have an increased risk of acquiring and transmitting bloodborne diseases, including HIV, hepatitis B and C virus. To manage HIV among people who use drugs and live with HIV (PUD-LWH), health services provide integrated Medication-Assisted and Antiretroviral Treatment Services (IMAT services). Although the IMAT comprehensive care package includes biological, social, and psychological interventions, PUD-LWH's retention in care is suboptimal. A formative needs assessment collected qualitative information to inform adaptation for PUD-LWH of an evidence-based peer-led group psychosocial intervention that showed good clinical and psychosocial outcomes in people living with HIV. Methods: We conducted in-depth interviews with 22 PUD-LWH to understand users' experiences with IMAT services. Healthcare providers (n=6) also participated. Thematic areas explored included perceptions of how the IMAT services process met users' needs, experiences when attending IMAT services, including perceived benefits and challenges, and proposed strategies to overcome reported difficulties. Narrative data were analyzed using thematic analysis. Results: PUD-LWH perceived themselves as physically and mentally stable and acknowledged that IMAT had helped them re-integrate with families. Enacted stigma, out-of-pocket healthcare expenses, and limited time with healthcare providers due to an overburdened IMAT service were challenges to maintaining adherence to IMAT clinic visits and ART medication use. Participants proposed strategies to continue building awareness of IMAT services, reduce enacted stigma related to drug use, enhance client psychosocial care, facilitate the provision of skills for improving income generation for PUD-LWH, and increase the number of IMAT healthcare providers. Conclusions: This formative study reveals individual, family, and community-level facilitators and barriers to accessing and using IMAT services and IMAT services-based structural challenges. IMAT services clients by suggesting strategies to overcome structural challenges.