Pilot of Methadone for Recently Incarcerated People with Human Immunodeficiency Virus and Opioid Use in South Africa.

In South Africa, there is no provision of medication for opioid use disorder (MOUD) for people who are incarcerated or were recently incarcerated. This study aimed to describe MOUD uptake and barriers among people living with human immunodeficiency virus and using illicit opioids reentering the community from incarceration. A mixed-method exploratory study was conducted between September 2021 and September 2022 in South Africa, during which we offered low-barrier MOUD and harm reduction services. We followed 23 participants postrelease and observed a low uptake of MOUD after release (8 of 23, 35%). Reported barriers to MOUD included perceived ineffectiveness, a preference for residential withdrawal management, and delays in initiating MOUD. Innovation is needed in strategies to deliver MOUD and harm reduction in South Africa.