Quality of life among people who inject drugs attending methadone clinic in Dar es salaam, Tanzania.

Abstract

Introduction: Injecting drug use is one of the emerging public health challenges that Sub -Saharan Africa is facing today. Most people who injecting drug (PWIDs) succumb to poor health conditions, including physical health, mental health and other social disadvantages. This is mostly due to dependency and other risky health behaviours which may include trading sex for drugs or money to buy drugs, sharing needles, injecting equipments or blood itself through “flash blood” or “vijipointi” injecting practises. Methadone Assisted Therapy (MAT) reduces dependency to opioid and therefore establishment of methadone clinic established at Muhimbili National hospital (MNH) two years ago with other interventions aim at reducing these risks and hence improves quality of life in this subpopulation. Objectives: This study was designed to examine the Health Related Quality of Life (HRQOL) of people who inject drugs (PWIDs) attending Methadone clinic at Muhimbili National Hospital. Understanding clients’ own perspective of what changes have occurred and what those changes mean to their wellbeing was another important aspect of this study so as client centred approach should be applied when addressing their needs. Methods: This was a pre-post longitudinal study and qualitative data collection method. Archived clients records were retrieved to obtain assessment information from electronic and paper database systems. Out of 385 clients records utilized at the baseline, 293 were compared to assess the change on HRQOL. A total of 21 participants were recruited for in depth interviews and focus group discussions. SF 12 MOS quality of life survey version 1 was used for assessment of HRQOL. Paired Student t – Test and Independent t – Test were used to compare the mean of HRQOL of participants before and after methadone treatment and to compare the mean HRQOL score of participants and known Normative HRQOL of standard Dar es Salaam population. Multiple linear regression analysis was conducted to examine the associations between HRQOL and socio–demographic factors, physiological and addiction related function factors.

Results A total of 385 of clients’ record were reviewed of which 348 (90.4%) were male. Only 293 (76.1%) of those records were re-evaluated after initiation of methadone treatment due to various reason related to loss to follow up or poor quality of data. Male participants were older with the mean age of 34.12 years as compared to that of female of 30.43 years (p<0.001). Overall HIV prevalence was 47.7% and that of female and male participants being 67.6%, 31.9% respectively, this difference between the two prevalence was statistically significant (p<0.001). There was statistically significant lower prevalence of hepatitis B (18.9% vs. 22.1%, p = 0.012) and C (24.3% vs. 43.4%, p= 0.012) for female participants as compared to their male counterparts. The mean scale score for all domains of HRQOL for PWIDs after methadone treatment were higher than before initiation of treatment. These were also higher than those of general population for Dar es Salaam except for social function scale where there was no difference and for general health scale in which the general population had a higher score. Increase in number of working days improved both Physical and Mental Composite Scale score by 0.132 and 0.131 standard units respectively. In addition, an increase in number of cognitive deficits impaired Physical Composite Scale score by 0.146 standard units while an increase in number of psychotic experiences impaired Mental Composite Scale score by 0.133 standard units. Moreover, participants appreciated the changes in various aspects of their lives such as health, safety, housing and majority of them associated poor health outcome in various areas of function with inability to control symptoms of heroin dependence. Conclusion: Methadone assisted therapy improves Health Related Quality of Life of people who inject drugs. Clients appreciated the impact methadone therapy has on many areas of their lives, not limited to physical and mental health. Having a job improves both physical and mental components of quality of life whereas experiencing psychotic symptoms affect mental component and having cognitive impairment affect physical component of Quality of Life. Recommendation: Scaling up of Methadone assisted therapy is needed to improve HRQOL of people who inject drugs. Thorough mental state examination and feasible occupational or income generating scheme needs to be designed to ensure the comprehensive nature of the intervention for better outcome of PWIDs. Further and bigger evaluation studies using extensive tools and large numbers of participants are required to exploring the dynamics of heroin addiction in this virgin community.