Factors influencing the uptake of harm reduction services by people who inject drugs in Nairobi, Kenya

Abstract

Background: Injected drugs cause significant health and social problems, and harm reduction services (HRS) offered to people who inject  drugs (PWIDs) is the mainstay of its management. The factors associated with HRS provision remain unclear in Nairobi.

Objective: To  investigate the factors influencing the uptake of harm reduction services among PWIDs in Nairobi.

Design: Mixed methods approach  involving quantitative and qualitative data Setting: Drop-in centers and community Subjects: 231 PWIDs, 8 peer educators and 4 service  providers

Results: Of 231 PWIDs (male = 189; 81.82%), 158 (68.40%) were aged ≥25 years, and 109 (47.19%) had used drugs for 4-10 years.  Only 94 (40.69%) participants had used harm reduction services (HRS) for >3 years. Respondents who had used HRS for <1 year were 2.43  times more likely to utilize HRS than those over 3 years of use (p<0.05). Mode of transport to DIC (OR=2.04; p=0.002), attending each visit  (OR=1.24, 95% CI 0.28-1.98; p=0.015), service duration (OR= 3.19; p=0.001), and service quality (OR=1.43; p=0.031) influenced HRS  utilization. Those accessing HRS at both DIC and outreach were 1.34 times more likely to utilize HRS than those who accessed from  centres only (p=0.012).

Conclusion: Uptake of HRS was low in Nairobi, although PWIDs were satisfied with the services. Distance and  means to the nearest DIC, time spent at DIC, and quality of service influenced HRS uptake. The government should increase the number  of DICs and outreaches for enhanced HRS uptake.