To improve ART initiation among people who inject drugs, the investigators propose to develop and pilot a multi-component Integrated Methadone and Antiretroviral Therapy strategy (IMAT) in Dar es Salaam, Tanzania. In doing so, the investigators anticipate building a functional model of methadone and ART integration that improves the effectiveness and efficiency of service delivery.
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Inclusion Criteria: Methadone clients living with HIV but not linked to ART are the primary study population. Inclusion criteria for methadone initiation: 1. opioid dependence 2. positive urine screening for opiates. Additional inclusion criteria include: 3. age ≥ 18 years of age 4. HIV-positive. Individuals must also be willing to provide informed consent and be fluent in Kiswahili or English to participate in cross-sectional surveys and in-depth interviews Exclusion Criteria: We will exclude methadone clients from this study who have 1. received ART prior to methadone initiation 2. received a tuberculosis-positive diagnosis 3. women who are pregnant. The investigators have excluded clients who have received ART in the past as their inclusion would bias our study results. The investigators have also excluded patients with a tuberculosis diagnosis or women who are pregnant as they have a unique and urgent need for treatment and should be initiated onto ART regardless of their CD4 count