Mudiope Peter, Nanyeenya Nicholas, Simon Okurut, Twimukye Adelline, Simon Kibira, Brian Mutamba Byamah, Nangendo Joan, Alamo Stella, Makumbi Fredrick, Wanyenze Rhoda, Matovu Joseph Kb
Makerere University School of Public Health.
Makerere University.
Res Sq. 2025 Jun 17:rs.3.rs-6819472. doi: 10.21203/rs.3.rs-6819472/v1.
Despite strong evidence supporting medication for opioid use disorder (MOUD), acceptability varies considerably across contexts. This study explored client and provider perspectives on MOUD acceptability among people who inject drugs (PWID) in Kampala, Uganda.
We conducted a qualitative descriptive study during November and December 2023 in Kampala Capital City, Uganda. In-depth interviews with 20 PWID (10 enrolled, 10 not enrolled) and key informant interviews with 10 MOUD service providers were conducted. Data were analysed using thematic analysis, guided by the Theoretical Framework of Acceptability (TFA) and managed with ATLAS.ti software.
MOUD was highly acceptable among providers, enrolled and non-enrolled participants. Facilitators included comprehensive, person-centered services that addressed health and psychosocial needs, supportive family relationships, alignment with personal recovery goals, and the safety and effectiveness of supervised medication therapy. However, participants encountered significant barriers. Structural challenges such as high transport costs, limited clinic operating hours, and strict enrolment criteria impeded access and continuity. Fear of arrest due to drug criminalization and stigma, both societal and within healthcare settings, further discouraged engagement. Additionally, some participants questioned methadone's effectiveness relative to heroin and reported widespread reliance on traditional and spiritual healing practices, often coerced by family members. Social norms promoting mutual drug-sharing as a symbol of trust were disrupted by MOUD enrolment, resulting in peer resistance and social isolation.
MOUD was highly acceptable among PWID and providers in Uganda, valued for its effectiveness in restoring health and stability. However, structural barriers, stigma, misinformation, and restrictive enrolment often drove PWID to non-evidence-based treatment. Flexible service models, simplified enrolment procedures, community sensitisation, and collaboration with abstinence-based providers and law enforcement are vital to improving MOUD acceptability.
尽管有强有力的证据支持药物治疗阿片类物质使用障碍（MOUD），但其在不同环境中的可接受性差异很大。本研究探讨了乌干达坎帕拉注射吸毒者（PWID）中服务对象和提供者对MOUD可接受性的看法。
2023年11月至12月，我们在乌干达坎帕拉首都进行了一项定性描述性研究。对20名注射吸毒者（10名已登记，10名未登记）进行了深入访谈，并对10名MOUD服务提供者进行了关键信息提供者访谈。数据采用主题分析法进行分析，以可接受性理论框架（TFA）为指导，并使用ATLAS.ti软件进行管理。
MOUD在提供者、已登记和未登记参与者中都非常可接受。促进因素包括满足健康和心理社会需求的全面、以人为本的服务、支持性的家庭关系、与个人康复目标的一致性以及监督药物治疗的安全性和有效性。然而，参与者遇到了重大障碍。诸如交通成本高、诊所营业时间有限和严格的登记标准等结构性挑战阻碍了获取和连续性。由于毒品定罪和污名化导致的被捕恐惧，无论是在社会层面还是在医疗环境中，都进一步阻碍了参与。此外，一些参与者质疑美沙酮相对于海洛因的有效性，并报告广泛依赖传统和精神治疗方法，这些方法往往是由家庭成员强迫的。促进相互分享毒品作为信任象征的社会规范因MOUD登记而受到破坏，导致同伴抵制和社会孤立。
MOUD在乌干达的注射吸毒者和提供者中非常可接受，因其在恢复健康和稳定方面的有效性而受到重视。然而，结构性障碍、污名化、错误信息和限制性登记常常促使注射吸毒者寻求非循证治疗。灵活的服务模式、简化的登记程序、社区宣传以及与基于禁欲的提供者和执法部门的合作对于提高MOUD的可接受性至关重要。
