title: Implementation and Operational Research: Linkage to Care Among Methadone Clients Living With HIV in Dar es Salaam, Tanzania.
abstract: BACKGROUND
  The first methadone maintenance treatment clinic in Tanzania was launched in February 2011 to address an emerging HIV epidemic among people who inject drugs. We conducted a retrospective cohort study to understand factors associated with linkage to HIV care and explore how a methadone maintenance treatment clinic can serve as a platform for integrated HIV care and treatment.
  
  
  METHODS
  This study used routine programmatic and clinical data on clients enrolled in methadone at Muhimbili National Hospital from February 2011 to January 2013. Multivariable proportional hazards regression model was used to examine time to initial CD4 count.
  
  
  RESULTS
  Final analyses included 148 HIV-positive clients, contributing 31.7 person-years. At 30, 60, and 90 days, the probability of CD4 screening was 40% [95% confidence interval (CI): 32% to 48%], 55% (95% CI: 47% to 63%), and 63% (95% CI: 55% to 71%), respectively. Clients receiving high methadone doses (≥ 85 mg/d) [adjusted hazard ratio (aHR): 1.68, 95% CI: 1.03 to 2.74] had higher likelihood of CD4 screening than those receiving low doses (<85 mg/d). Clients with primary education or lower (aHR: 1.62, 95% CI: 1.05 to 2.51) and self-reported poor health (aHR: 1.96, 95% CI: 1.09 to 3.51) were also more likely to obtain CD4 counts. Clients with criminal arrest history (aHR: 0.56, 95% CI: 0.37 to 0.85]) were less likely to be linked to care. Among 17 antiretroviral therapy eligible clients (CD4 ≤ 200), 12 (71%) initiated treatment, of which 7 (41%) initiated within 90 days.
  
  
  CONCLUSIONS
  Levels of CD4 screening and antiretroviral therapy initiation were similar to Sub-Saharan programs caring primarily for people who do not inject drugs. Adequate methadone dosing is important in retaining clients to maximize HIV treatment benefits and allow for successful linkage to services.
authors.affiliation: *Pangaea Global AIDS, Oakland, CA; †Pangaea Global AIDS Foundation, Yale University, Cornell Scott-Hill Health Center, New Haven, CT; ‡Department of Psychiatry and Mental Health, Muhimbili National Hospital, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; §Mental Health and Substance Abuse Unit, Department of Curative Services, Ministry of Health and Social Welfare, Dar es Salaam Tanzania; and ‖Pangaea Global AIDS, Oakland, CA, Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, Department of Global Health, University of Washington, Seattle, WA.
authors.forename: Olivia C
authors.initials: OC
authors.lastname: Tran
authors.forename: Robert Douglas
authors.initials: RD
authors.lastname: Bruce
authors.forename: Frank
authors.initials: F
authors.lastname: Masao
authors.forename: Omary
authors.initials: O
authors.lastname: Ubuguyu
authors.forename: Norman
authors.initials: N
authors.lastname: Sabuni
authors.forename: Jessie
authors.initials: J
authors.lastname: Mbwambo
authors.forename: Barrot H
authors.initials: BH
authors.lastname: Lambdin
mesh_terms: D000328:Adult; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment / Q000379:methods*; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000188:drug therapy*; D013636:Tanzania
chemical_list: D008691:Methadone