Retention of service users on opioid substitution therapy in the City of Tshwane, South Africa

• Published in: African journal of primary health care & family medicine 2023, Vol.15 (1), p.e1-e10
• Main Authors: Goeieman, Daniela S., Nonyane, Dimakatso S., Nzaumvila, Doudou K., Janse van Rensburg, Michelle N. S.
• Format: Article
• Language: English
• Subjects: Abstinence; Adult; Analgesics, Opioid - therapeutic use; Biology; Community-Oriented Primary Care (COPC); Community-Oriented Substance Use Programme (COSUP); Drug dosages; Drug use; Epidemiology; Evidence-based medicine; Harm reduction; Health Care Sciences & Services; Hepatitis; Heroin; HIV; Human immunodeficiency virus; Humans; Immune system; Male; Medicine, General & Internal; Methadone; Methadone - therapeutic use; Narcotics; Nyaope; Opiate Substitution Treatment; Opioid dependence; opioid substitution therapy (OST); Opioid-Related Disorders - drug therapy; Original Research; Patient compliance; Poverty; Primary care; Qualitative research; Rehabilitation; Retention; Skill development; South Africa; Substance abuse; Substance abuse treatment; Substance use; Tuberculosis
• ISSN: 2071-2928; 2071-2936; 2071-2936
• DOI: 10.4102/phcfm.v15i1.3392

Background Opioid substitution therapy (OST) is evidence-based treatment for opioid use disorders and, when taken as maintenance therapy, has proven health and social benefits. The benefits of OST are achieved through the retention of service users in the treatment programme.Aim To identify factors that affected retention of service users who had OST interrupted in less than 6 months of being in an OST programme.Setting This qualitative study was conducted with 19 service users from eight Community-Oriented Substance Use Programme (COSUP) sites in the City of Tshwane, Gauteng, South Africa.Methods Participants were COSUP service users who had interrupted OST in less than 6 months since initiation and were purposefully selected from all COSUP sites. Demographic information was obtained and four focus group discussions covered challenges of OST retention. Discussions were recorded, transcribed and qualitatively analysed using Attride-Stirling’s thematic networks framework.Results The 19 participants were all male, mostly black African, with a mean age of 26 years. Facilitators of retention in OST were individual readiness to change OST accessibility, positive family and peer support, treatment monitoring, understanding and managing expectations of service users, contribution in society and meaningful opportunities for engagement. Barriers were the cost of OST, bureaucracy within the programme, inability to communicate challenges timeously and effectively to treatment providers, boredom, cravings and poverty.Conclusion Opioid substitution therapy programmes can ensure a holistic approach to prevent and treat harms related to illicit opioid use if they remain person-centred and are well-funded.Contribution Understanding the barriers to, and facilitators of retention on OST can contribute to improved community-based service delivery.