The pathway to establishing and implementing opioid agonist therapy (OAT) for people who inject drugs in Nairobi, Kenya.

Sub-Saharan Africa (SSA) is experiencing a burgeoning population of people who inject heroin. This has created an urgent need for the scale-up of comprehensive harm reduction services including medication for opioid use disorders. The rise in illicit drug use threatens the gains made in the fight against HIV in this high HIV burden region. People who inject drugs (PWID) have an increased risk of HIV acquisition and transmission due to factors such as needle sharing and engaging in high-risk sexual behaviors. Estimates show that PWID have a prevalence of HIV of 18.7%-nearly four times the prevalence in the general population in Kenya. To address this, Kenya adopted the comprehensive harm reduction package of services for PWIDs and in 2013, began preparation for the provision of Opioid Agonist Therapy (OAT) with the first clinic opening in 2014 at Mathari National Teaching and Referral Hospital (MNTRH). This paper describes the process and collaborative steps taken in establishing the OAT program in Kenya. It shares implementation achievements and lessons learned. Since the inception of OAT services in Mathari and Ngara clinics in Nairobi, over 80 healthcare providers were trained on the provision of OAT services between 2014 and 2023, and 3,354 individuals were initiated on OAT. The OAT program has expanded to include mobile OAT dispensing and satellite dispensing clinics, and in future, may include the use of take-home doses of Methadone and Buprenorphine and provide injectable long-acting Buprenorphine for increased uptake and continuity in treatment.