MOAB0403 | EXPLORING SOCIAL DETERMINANTS OF METHADONE MAINTENANCE TREATMENT DISENGAGEMENT AMONG PEOPLE WHO USE DRUGS-MOMBASA, KENYA

Alfred Karisa | Reachout Centre Trust, Voi, Kenya

Methadone Maintenance Treatment (MMT) is a proven, evidence-based intervention for opioid use disorder. Despite its effectiveness, treatment adherence remains a major challenge. New evidence shows that social factors like unstable housing, unemployment, stigma, and a lack of social support can affect how long people stay in treatment and how well they do. This study explores the impact of key social determinants on disengagement from MMT among people who inject and use drugs (PWUD), with the goal of identifying factors contributing to defaulting from treatment. A mixed-methods design was employed. Quantitatively, we conducted a retrospective review of clinical records from a methadone clinic that serves PWUD, referred by the Reach Out Center Trust in Mombasa, Kenya. Logistic regression was used to identify predictors of treatment default. Qualitatively, semi-structured interviews were conducted with one identified defaulter and 33 clients classified as lost to follow-up (LTFU). Thematic analysis was applied to explore narratives surrounding disengagement. Unemployment (88%, 30/34), lack of family support (74%, 25/34), and experiences of stigma and discrimination (76%, 26/34) were significantly associated with treatment disengagement. Qualitative findings corroborated these results, highlighting the interaction among economic adversity, social exclusion, and detrimental health-seeking behavior. Social determinants—particularly economic instability and social marginalization—play a pivotal role in methadone treatment disengagement. Targeted interventions such as employment support programs, stigma reduction strategies, and family-based psychosocial support are essential to improve MMT retention and enhance recovery outcomes among PWUD.