CommentaryTowards “evidence-making intervention” approaches in the social science of implementation science: The making of methadone in East Africa
Section snippets
HIV, addiction, and East Africa
The East African countries of Kenya and Tanzania are witnessing growing HIV incidence linked to drug injecting. In Kenya, for example, estimates of HIV prevalence among people who inject drugs (PWID) are as high as 50% in Nairobi and 20% in Coast Province (NASCOP, 2012). Prior to the introduction of MT (December 2014 in Kenya, and March 2011 in Tanzania), treatment for heroin addiction largely comprised private-only short-term residential detoxification and rehabilitation, affordable to few,
Evidence-based intervention
The introduction of MT into East Africa is primarily cast as an instance in the translation of evidence-based biomedical interventions in global health into new settings, of which a key element is expanding the international evidence-base in its support across different contexts of high and low income, within and beyond the West. There are parallels here with the building of global discourses of evidence-based harm reduction more broadly, which accentuate the potential positive effects of a
Evidence-making intervention
Rather than evidencing known interventions as responses to given policy problems, we advocate a critical social science approach which asks how such evidence, intervention and problem came to be. This perspective draws first, on the study of ‘problematisations’, which investigates policy, science and other texts for what they represent and how they construct a problem which they purport to address (Bacchi, 2009, Bacchi, 2012), and second, on ‘actor-network’ theories, which investigate how
Context-made methadone meaning
The basic idea that methadone, as with any intervention, is somehow shaped by its context is a familiar one (Bourgois, 2000, Fraser and Valentine, 2008), and this is part of the mainstream rationale underpinning the need for an implementation science in the translation of evidence-based interventions (Duke & Thom, 2014). For instance, we can refer to the example of Russia, or that of the UK and U.S.A. Each demonstrate variable constitutions of methadone in context and time; that is, different
Multiple methadones
The idea that a given substance – like methadone – is subject to different interpretations on account of its context is the primary thrust in applied public health discourses for incorporating social science methods as part of implementation science approaches. In this theorisation, the substance itself remains the same, and it is the interpretations which differ. This is a kind of weak form of social constructionism which does not trouble the idea of the substance of methadone as an inanimate
The making of methadone in Kenya
We have begun to document methadone's implementation in Kenya through qualitative research. This has included longitudinal research, led by TR and AG, with 110 PWID in Nairobi (n = 30), Malindi on the North Coast (n = 50) and Ukunda on the South Coast (n = 30) undertaken in the two years prior to methadone's implementation (Rhodes, Guise, et al., 2015). Participants in this study had a mean age of 31 years (19–49) and were predominately male (70%; 76). All but two had injected in the last four weeks,
Conclusions: friction and flux
In this commentary, we have depicted the object of methadone as multiple, open to negotiation, and crucially, the product of competing inscriptions arising from actor-networks of local effect. We have illustrated this through the specific example of the making of ‘methadone treatment promise’ in Kenya. The making of methadone promise and expectation arises out of a friction in conversation between as well as across global and local representations of what constitutes methadone, and
Acknowledgements
This commentary was developed through a visiting lecture invitation at the Center for AIDS Research at the University of California in collaboration with the University of California at San Diego. We are grateful to the International AIDS Alliance for supporting our work researching the development of harm reduction in Kenya, and to participating outreach projects who have assisted with our fieldwork (Omari Project, Malindi; Nairobi Outreach Services Eastlands Team, Nairobi; TeensWatch,
References (40)
The rise, fall, and revival of recovery in drugs policy
Lancet
(2012)- et al.
Lessons from Tanzania on the integration of HIV and tuberculosis treatments into methadone assisted treatment
International Journal of Drug Policy
(2014) - et al.
Prevention of HIV infection for people who inject drugs: Why individual, structural and combination approaches are needed
Lancet
(2010) The social life of drugs
International Journal of Drug Policy
(2013)- et al.
The role of evidence and the expert in contemporary processes of drugs policy governance: The case of opioid substitution treatment in England
International Journal of Drug Policy
(2014) Opioid substitution treatment in Tajikistan: Another perpetual pilot?
International Journal of Drug Policy
(2010)- et al.
HIV prevention. treatment, and care services for people who inject drugs: A systematic review of global, regional, and national coverage
Lancet
(2010) - et al.
HIV and risk environment for injecting drug users: The past, present, and future
Lancet
(2010) - et al.
Controlling HIV among people who inject drugs in Eastern Europe and Central Asia: Insights from model projections
International Journal of Drug Policy
(2014) Evidence-based global public health
Analysing policy: What's the problem represented to be?
Why study problematisations? Making politics visible
Open Journal of Political Science
Symptom: Subjectivities, social ills, technologies
Annual Review of Anthropology
Disciplining addictions: The bio-politics of methadone and heroin in the United States
Culture Medicine and Psychiatry
A sociology of expectations: Retrospecting prospects and prospecting retrospects
Technology Analysis and Strategic Management
Anthropologies in and of evidence making in global health research and policy
Medical Anthropology
Realities of replication: Implementation of evidence-based interventions for HIV prevention in real-world settings
Implementation Science
Habits: Remaking addiction
Substance and substitution: Methadone subjects in liberal societies
Methadone: Six effects in search of a substance
Social Studies of Science
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