In the quiet towns and busy streets of Kiambu County, Kenya, a quiet revolution has been taking place – one that has changed lives, rebuilt families and restored hope for people struggling with drug use.

This is the story of the Kiambu People Who Use Drugs (PWUD) Project, a bold public health initiative that sought to rewrite the narrative of addiction, not with punishment or shame but with dignity, care, and evidence-based solutions.

“For years, people who used drugs in Kiambu, particularly heroin and opium were among the most marginalised members of society. They faced stigma at every turn; in hospitals, on the streets, even at home,” said Morris Kariuki Chege, Haven Addiction Centre (patient led organization), Kiambu chairperson.

Chege said access to treatment was limited or non-existent and the few who attempted recovery often fell through the cracks due to poverty, discrimination or lack of follow-up care. He added in particular, women who used drugs suffered unique challenges, including gender-based violence, social exclusion, and an almost total absence of gender-sensitive services,” added Chege

That began to change in 2021 when the Kiambu PWUD Project was launched with support from the government and development partners.

“The approach was both simple and radical: meet people where they are, offer them comprehensive health services and walk with them on their journey to recovery. This meant not only providing medically assisted therapy (MAT) like methadone and buprenorphine, but also addressing the broader health and social needs of clients,” said John Mbau, NASCOP, Key and Vulnerable Population Program Manager.

Mbau said they liaised with clinics that he noted offered HIV, TB and STI screening and treatment, mental health support, nutrition services, sexual and reproductive health care, and even cancer screening.

One of the most transformative innovations was the establishment of the Empowerment Centre, where clients could learn practical skills like tailoring or computing to rebuild their lives beyond drug use.

Meanwhile, community outreach programs brought services closer to people through mini-clinics and satellite dispensing sites, while also training former drug users to become peer educators. These peers played a crucial role in building trust and encouraging others to join and stay in the programme.

The results speak volumes.

“Between April 2021 and June 2024, over 1,600 individuals enrolled in MAT, most of them young men around the age of 28. More than 70 per cent stayed on treatment, a remarkably high retention rate in addiction care. Relapse rates fell to just under five per cent and the mortality rate dropped to 2.9 per cent,” said Angela Thiong’o- MSF Kiambu Project Medical Referent.

Thanks to early testing and consistent care, rates of HIV, hepatitis C and TB among clients remained low. Some even began preventive HIV treatments like PrEP and PEP, a testament to the shift from crisis response to long-term health planning.

“These numbers, while impressive, only tell part of the story. The real impact came through the lives transformed, clients who reconnected with their families found employment or began new journeys as peer mentors. Others broke free from cycles of incarceration or homelessness. Health workers, too, reported a new sense of purpose as they saw the power of a compassionate, holistic approach to care,” said Dr Hillary Kagwa, County Director of Health, Kiambu County.

Kiambu’s experience began drawing attention nationally. The project became a model site for training MAT providers and played a key role in shaping emerging national policies on harm reduction, including guidelines for take-home dosing and MAT access in prisons.

Yet even with these gains, the project faced serious limitations. Women who use drugs (WWUD) remained underrepresented, making up just 7.7 per cent of clients. Many were deterred by stigma, fears of losing child custody or lack of childcare at clinics. The shortage of trained addiction counsellors meant that staff had to learn on the job, often under pressure.

Health workers outside the program on the other hand remained sceptical, and approvals for take-home medication were slow, reducing convenience for stable clients. Most critically, in 2023, a sudden freeze in donor funding forced the project to wind down prematurely. The last MAT clinic was opened only 11 months before the handover, leaving little time to assess its stability or ensure long-term sustainability.

Looking ahead, the lessons from Kiambu point to several strategic priorities for future harm reduction efforts. Expanding mini-MAT clinics and satellite dispensing sites will reduce travel barriers and improve treatment consistency. Besides extending services into prisons is essential to ensure incarcerated individuals receive uninterrupted care.

Strengthening the role of peer educators and supporting client led organisations can deepen trust and improve retention. Advocacy for policy reform must continue to streamline access to take-home doses and improve coordination across sectors.

Digital health systems are another frontier. Shifting from paper-based to electronic health records would greatly improve client tracking and service efficiency. Most importantly, programs must design gender-specific interventions, including childcare support and trauma-informed care, to better serve women.

Conducting midterm evaluations, not just end-of-project studies, would also allow programs to adapt in real time and make course corrections.

The Kiambu PWUD Project may have come to an early close, but its legacy endures. It demonstrated that people who use drugs are not lost cases, but human beings worthy of respect, care, and second chances. It proved that when health systems offer integrated, people-cantered services, lives can and do change.

This was more than a health intervention; it was a shift in thinking. One that showed how science, policy, and empathy can come together to heal not just individuals, but entire communities.

• A Tell Media / KNA report / By Violet Otindo

PWUD receiving methadone treatment

Needles used by PWUD at one of the dens

PWUD waiting for medication at Karuri MAT clinic

National and County health officials and partners at the handover ceremony