Jessie Mbwambo, Muhimbili National Hospital (MNH) and Muhimbili University of Health and Allied Sciences (MUHAS

1. Jessie Mbwambo, Muhimbili National
Hospital (MNH) and Muhimbili University
of Health and Allied Sciences (MUHAS)

2. Presentation format

 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

3. Definition of Implementation
Sciences (IS)

 to translate effective
IS is the study of approaches
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.

4. Framework for IS


5. 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 .

6. 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

7. 
IS Framework#2
 be targeted among the
Deciding where change(s) must
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.

8. 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.

9. 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

10. 
IS framework 4……….

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.

11. Value of Implementation
Science


13. Injecting drug users and HIV

 reported presence
Globally 151 countries have
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

14. Prevention of HIV among
PWIDS in Dar es Salaam

 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

15. Prevention#2
 TAPP at the forefront of efforts in subSaharan 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 communitybased, clinical and state level interventions to
address different levels of vulnerability

16. Injection drug users programing
at MUHAS


17. Identify programmatic gaps

 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

18. Identifying program gaps 2

delivery: Methadone
Inequities in health care
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-esSalaam
 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

19. Developing and implementing
strategies


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

20. IS 3 and IS 4

 IS 3: Measuring effectiveness and
efficiency
 Young program not yet there
 IS 4: Utilizing information
 Young program not yet there

22. 
Research Gaps
Surveys (IBBS) needed to
Integrated Bio Behavioural
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