Contribution of the workforce to retention of clients in Kombani Medically Assisted Therapy (MAT) in Kwale, Kenya.

Background
The compounding ripple effect of opiate dependance is associated with dispropotionate factors negatively affecting the wellbeing and eventually quality of life of the drug enthusiast and the affected community.  A risk of people using drugs by as much as 40% in Africa by 2030 was documented by UNODC world drug report 2021. In Kenya heroin contributes to 15% of the burden of substance use disorder according to National Campaign Against Drug Abuse, (NACADA,2022), with Kwale county having a number of 2,479 persons experiencing opiate dependence as per National Aids and STI Control Program, (NASCOP-MOH,2019). Kombani Medically Assisted Therapy (MAT) health center in Kwale, has so far inducted 1020 clients on outpatient set up from civil societies since its inception.  It has maintained a streak of over 70% retention in the past 2years.  Low and middle income countries achieve an average of 50% retention of clients according to research by feelemyer,2013.  This retention rate does press on the need for research on retention on opiate agonist treatement according to (emcdda.europa.eu 2021) article on opioids health and social responses.  The objective of the study was to find out how the wellbeing of the workforce contributes to retention of the clients in MAT outpatient delivery set up.
Methodology
An analysis was done by observation of adherance to MAT and follow up on clinical appointments, to compare data of 205 clients, that were inducted between the year 2020-2021 and were retained to 2023 with 205 clients inducted between 2018-2020, before integration of collective well being to kombani MAT workforce.  Departmental journaling of daily occurrence as a wellbeing practice fed into weekly debrief sessions and pointed the workforce to practice: -

• Flexible scheduling of clients appointments
• Intentional and inclusive case by case management of clients.
• Referral by linkage or escorting of clients for further medical interventions.
• Strengthened engagement with civil societies.

Results
Analysis showed that 88% of the clients inducted in 2020-2021 were retained as compared to the retention rate of 55% of those that were inducted between 2018-2020. Out of this 88%, 93%  had an up to date treatment plan with personalised recovery schedule, with 7% having habitual missed appointments. Of those on assisted aderance to HIV 99% had undetectable viral load.
Conclusion
This study shows that conditions for transformation are better cultivated from a point of wellbeing. This creates strong therapeutic relationship in an atmosphere of safety and trust between the workforce and the clients. It plays a key role in clients commitment to follow up with freedom to choose own recovery schedule. However, there's need to carry out related studies.