Background Medically Assisted Therapy (MAT) in Kenya MAT
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Quality Medically Assisted Therapy (MAT) for Opioid Dependent Persons in Mombasa County: Using a same-page approach A Baghazal1, L Tariko2, G Nzomo2, S Kayanda1, M Abdi1, K Shikely1, S Patta1, I Khandwalla2, Z Ahmed1, H Musyoki3, P Macharia3, E Mwamburi4, S Bertrand5, S Abdallah5 Institutional Affiliation 1 Mombasa County Government, Department of Health, Mombasa, Kenya 2 Coast General Hospital, Mombasa, Kenya 3 Ministry of Health National AIDS and STI Control Programme, Nairobi, Kenya 4 United States Agency for International Development, Nairobi, Kenya 5 United Nations Office on Drugs and Crime, Regional Office for Eastern Africa , Nairobi, Kenya Fig 2: Chief Officer, Health, Dr. Shikely(Right), Background Fig 1: Map of Kenya showing location of MAT sites in Nairobi and Mombasa launching the MAT programme in Mombasa Injecting drug use documented in Nairobi & coast regions since 1990s Estimated 18,327 PWID in Kenya, almost half are in coast region PWID HIV prevalence 18.3% versus 5.6% for general adult population In response, National AIDS and STI Control Programme (NASCOP) with UNODC ROEA and USAID/PEPFAR initiated HIV combination preven- tion, care and treatment for PWUD Programme, alias AFYA-PWID Other key partners: Mombasa, Kilifi and Kwale Counties and CSO partners implementing harm reduction—MEWA & Reachout Centre Trust Medically Assisted Therapy (MAT) in Kenya Medically Assisted Therapy (MAT) program alias Opioid Substitution Use of MAT Client Card by Service Providers Therapy initiated in Dec 2014 in Nairobi and in Coast region in 2015 CSO Drop-in-Centre by Addiction Counselor or Clinician By Dec 2015 almost 900 PWID/PWUD accessing MAT at 3 MAT Clinics: Fills a photocopy of Page 1: Mathari TRH: 534, Malindi SCH: 169, Coast General Hospital: 169 •Socio-demographics •Drug Use History MAT Service Delivery Tools by Client Flow •Psychosocial, medical and mental history To facilitate ongoing data capture and reporting of MAT and evidence- •Family drug use and medical history based programming, NASCOP and its partners developed 22 M&E tools for various MAT service delivery points at health facility and CSO levels. MAT Clinic: Reception by Health Records Information Officer •Page 1: Socio-demographics Fig 3: relevant tools used at various service de- livery points in the MAT programme However, upon pilot at Triage by Nurse: •Page 1: drug use history •Page 2: presenting complaint, vital signs, BMI, COWS Laboratory by Lab Technician • Lab test results Consultation by Clinician •Page 1: History, MAT induction, HIV /TB diagnosis and treatment •Page 2-3: Current history, exam, diagnosis, treatment plan, referral. •Page 4: Additional notes as needed Psychosocial by Medical Social Worker Page 1: Drug use, psychosocial and family history; MAT therapeutic and behavioural outcomes at: 30 days, and months 3, 6, 9 and 12 Page 2-3: Social functioning Page 4: Additional notes as needed Key Strengths •Merges multiple tools: Forms 1a, 1b, 2a, COWs, Form 2b, 3a, 3b, 4a, etc. •Overview of client status in 4 pages: baseline profile, drug use behavior, co-morbidities, treatment adherence, change in life status. •Missing or incorrect data easily identified and corrected •Lighter work load Mathari, Malindi and Mombasa MAT Clinics, 22 tools reported as: •Improved quality of care: focus on client Questions burdensome, repetitive, •Promotes team work as all “on same page!” Increased staff work load Time-consuming, delayed patient care Critical Gaps Not environmentally friendly –too many papers Wear and tear of MAT Client Card due to frequent handling by multiple service providers Introduction to the MAT client card Poor storage of MAT Client Cards: A3 size too large for spring files In Oct 2015 UNODC with its partners rolled out simple MAT Client Card : Narrow columns for documenting clinical follow up visits Front page: Inadequate documentation and monitoring of quarterly treatment and Socio-demographics, Drug use, Psychosocial, Medical, Mental behavioral outcomes on front page. health and Family history MAT eligibility confirmation, induction and stabilization, monthly Next steps, conclusion treatment monitoring of retention and behavioural outcomes Address identified gaps with MAT Client Card design HIV /TB Diagnosis, drug regimens, retention, treatment outcomes Organize National M&E Meeting to build consensus among all MAT im- Page 2-3: follow up clinical reviews & referral as needed –20 visits plementers for country-wide adoption of MAT Client Card. Back page: Additional space Convene monthly and quarterly case review meetings for tracking MAT/ for clinical notes HIV/TB treatment progression and cohort outcomes. Automate MAT Client Card for easy data consolidation and analysis to guide decision making and programming Transform MAT Client Card into booklet that includes MAT Treatment Plan and Review, Treatment Adherence, Psychosocial Support, etc. Fig 5: View of the front page (Page 1) of the 4-Page A3-sized MAT client card. This section captures client Fig 5: Section of the Middle pages (pages 2-3) of the MAT client card, history, socio-demographics and co-morbidities that captures data at client initiation and subsequent follow up visits Fig 8: Coast General Hospital MAT Clinic Team Fig 7: HRIO filling MAT Client Card at Reception PRESENTED AT THE 21ST INTERNATIONAL AIDS CONFERENCE - DURBAN, SOUTH AFRICA .