The Infectious Diseases Institute, with funding from PEPFAR through Centers for Diseases Control and Prevention (CDC) supported the setup of a Medically Assisted Therapy (MAT) centre at Butabika National Mental Referral Hospital for People Who Inject with Drugs (PWIDs). This has been done in collaboration with the Ministry of Health and the Butabika hospital management as a way of supporting the Ministry of Health mandate.

Medically Assisted Therapy is the use of medications in combination with counselling and behavioural therapies. MAT is effective in the treatment of opioid use disorders and may help some people to sustain recovery.
In 2019, a National Key Population Size Estimate study conducted in Uganda revealed that drug use by injection is a growing problem with an estimated 11,034 people engaging in the practice. Most of these reside in Kampala, Wakiso and the eastern parts of the country. The 2018 Kampala Place Study estimates there are 18,000 (PWID) in Uganda with HIV and Hepatitis B (HBV) prevalence reported as 17 % and 20% respectively and compounded by underlying mental health problems. Drug users are highly stigmatized and criminalized for their drug use. Many get delays in access to HIV treatment in case of a drug overdose, mob justice and other co-morbidities. This has led to an increased mortality rate in people who use drugs living with HIV.

The primary goal of MAT is to reduce or stop opioid use in order to eliminate HIV and other harms associated with illicit injected opioid use. There are 3 major medications used; Naltrexone, Methadone and Buprenorphine. In Uganda, methadone and buprenorphine are recommended medications for MAT.
In order to support set up of the MAT centre, a course was organised in collaboration with the Ministry of Health and Butabika National Referral Mental Hospital. It combined both theory and practical approaches to build skills and knowledge in MAT service delivery for People Who Inject with Drugs (PWID). Forty-two people successfully attended this course including health workers, CSO staff, and programme staff.

“As we head to the final lap in our fight against HIV, there are many situations that can hinder proper medication among people in the community and this includes substance use. Integrations like this can help us work towards reaching our goal.” Dr Lisa Nelson the CDC Uganda Country Director said at her prelaunch visit to the centre.
As part of the start-up of the MAT centre, items worth USD 50,000 including furniture, computers, audio-visual equipment, automated dispensers among other clinical supplies were also handed over to the centre.

The 30,000USD Metha-Measure was also successfully installed. This is an automated computerised methadone dispensing system with improved commodity accountability and minimizes errors in dosing as the quantity per client is auto calculated. It has security features such as the finger biometrics required before dispensing is done.

MAT is provided as part of a comprehensive package of health services that include: the prevention, screening, diagnosis and treatment for HIV, tuberculosis (TB), viral hepatitis and sexually transmitted infections; targeted information, education and communication, condom promotion, psychosocial support, legal aid, etc. These feed into the IDI mission and vision to build a healthy Africa, free from the burden of infectious diseases and strengthen health systems.

By Rebecca Nakitandwe
Photography by Abubaker Kazibwe