Training on medically assisted therapy conducted in Kenya

On April 28-30, UNODC Kenya in collaboration with Ministry of Health and KANCO convened training at Serena hotel coast region in Mombasa. A total of 45 CSOs representatives attended: NOSET, SAPTA, MEWA, RCT, OMARI project, BOMU clinic, Teens watch and MDM. The training was facilitated by facilitators from NASCOP, UNODC, GOK Mathare mental clinic and KANCO.  The aim of this forum was to provide basic orientation on medically assisted therapy (MAT) and develop common understanding on key messages plus expected role and responsibilities for CSO service providers in partnership building and support for opiate users along the pathway to recovery. The training focused on the following objectives: to provide clear guidance on use of medications for, opioid agonist maintenance treatment (OAMT), prevention and management of opioid overdose, management of withdrawal and relapse prevention among persons dependent on opioids and to defines basic concepts of drug dependence and opioids, recommended procedures and minimum standards for good practices in MAT service delivery for different settings.

Partners implementing PWID programme shared how effective MAT programme can be implemented in the country. Since CSOs have an access to PWID, Harm reduction programmes implemented by Kenyan CSOs will become more comprehensive by adding MAT in the package of services. CSOs can serve as a good linkage between medical staff and PWID. Involvement of people who use drugs to work as peer educators will enhance services delivery to PWID. After a long discussion on roles and responsibilities of each party, CSOs agreed to support MAT programme by information dissemination on MMT, MMT demand generation, referrals to the MMT clinic and support capacity building of staff and other relevant resource people. The MMT clinics will only enrol clients referred by specific CSOs. Each CSO will have a target number of PWUD willing to be enrolled on MAT. PWUD who are HIV positive and on TB treatment may be given first priority if they are willing to be part of MAT programme.

Dr. Njuguna a psychiatrists at Mathare mental clinic urged CSOs to focus more on clients support and mental health since PWUD have many psychosocial issues that may require regular medical attention. He added that psychosocial support is an umbrella term that covers an array of non-pharmacological interventions for effective management of drug use. Psychosocial interventions enhances pharmacological treatment efficacy by increasing medication compliance, retention in treatment, and acquisition of skills that reinforce the effects of medication. He added there is a need to enhance psychosocial interventions by considering the following: addiction biology and treatment principles, basics counselling skills, motivating clients and addressing resistance, relapse prevention strategies, comprehensive care, support, rehabilitation and social reintegration.

CSOs agreed that family support will play a major role in enhancing mental health and sustainability of road to recovery among PWUD. A holistic approach that will entail the following: legal services, housing, food/self-care and transportation services, financial and employment services, educational and skills training services will contribute to the success of harm reduction services through MMT. With support from NASCOP technical unit, monitoring and evaluation system will be strengthened to ensure uniformity in all relevant documentation and a standardized data base system to be adopted. Carolyne (KANCO representative) shared case studies from the following countries: Malaysia, Indonesia, India and Kenya. The findings from these countries helped participants to understand why GOK and CSOs need to work as a team to support MAT programme in Kenya and why MAT dosage should be individualized. MAT dosage will vary from 10 mg to 80 mg depending on client’s needs. Dr. Saade from UNODC shared that high dosage may have severe side effects on PWUD. All newly enrolled clients will be under medical observation for at least 8 hours. These will allow close observation by clinicians. Though there is need to have safe shelters within MMT centres. CSOs willing to support this initiative will be highly appreciated. Carolyne emphasized since MAT is key component in harm reduction services, partners need to consider using available resources to attain what Kenya has planned for many years. Outreach workers and peer educators will continue to play a major role in reaching out to PWUD and she urged project manager to consider this resourceful team, by enhancing their working conditions.

The CSOs agreed NSP continues to be part of harm reduction services and CAHR will continue to support NSP component until end of 2014. KANCO has procured naloxone and is willing to share it with other partners after receiving official requests for Naloxone.

Participants of the workshop discussed further actions which include: scheduling National service providers’ meeting; creating demand for MAT as well as sensitizing community about the new programme and identifying MAT champions; organizing capacity building for service providers; creating friendly and safe environment at MMT centres; establishing livelihood projects for PWUD; conducting training on Naloxone administration and documenting success stories.