Background:
In 2017, 4.6million Nigerians reported non-medical use of prescription opioids with 87,000 using Heroin. The national Opioid Agonist Maintenance Treatment (OAMT) program is scheduled to start initiations from March-2025 in Gombe State. Aligning with 2022 national guidelines, the OAMT program will offer daily formulations of buprenorphine or methadone. Long-Acting Depot Buprenorphine (LADB) is a newer-generation of OAMT with weekly/ monthly injections which could improve treatment outcomes.
Description of intervention:
Under the Unitaid funded multi-country HepC3P study, LADB will be integrated within OAMT services to investigate client drug preference. However, unique to Nigeria, LADB will be offered alongside daily OAMT in a fully-treatment naïve population, rather than integrated within an existing OAMT service. This novel approach required extensive engagement with the national programme, local stakeholders and communities, alongside capacity building and procurement support, to elicit sign-off. We argue that the Nigerian experience of developing LADB implementation research alongside the establishment of the national programme provided health system-efficiencies that advanced the rollout of the national programme (framed through WHO-2007 building-blocks).
Effectiveness:
Stakeholder engagement efforts at national level facilitated policy development; LADB clinical protocols will be adopted in national policy, informed through state Community Advisory Board (CAB) (1. Leadership). The importation of OAMT commodities was strengthened with co-development of the national-distribution algorithm, (2. Medical Products). Enhanced combined clinical training was provided for healthcare workforce (3. Health workforce). Data-driven decision support mechanisms were co-developed to determine appropriate sites for national program and study-site implementation (4. Information, 5. Service Delivery, and 6. Finance.).
Conclusion and next steps:
LADB implementation research was effectively used to strengthen national OAMT programming in Nigeria. If LADB is considered acceptable/preferable to participants, this model could provide a crucial template for how OAMT-naïve countries administer national OAMT programmes and inform drug quantifications – with the potential to offer long-acting alternatives de-novo. |