With opiate use documented in over half of the countries of Africa, injecting drug use reported in most of these, and linked emerging concentrated epidemics of HIV and hepatitis C infection among people who inject drugs (PWID), there is increasing attention on the incorporation of harm reduction interventions as part of national drug policy responses in African countries (Abdool, 2016, Ratliff et al., 2013, Rhodes et al., 2015a, Rhodes, Ndimbii, Guise, Cullen, & Ayon, 2015). The focus of interest in relation to implementing HIV and hepatitis C prevention is contextualised by longer-standing and broader concerns linked to indicators of growing drug markets, especially of heroin in the East African countries of Kenya and Tanzania (Beckerleg and Hundt, 2004, Carrier and Klantschnig, 2012, International Narcotics Control Board, 2014, Mbwambo et al., 2012, UNODC, 2013a, UNODC, 2013b). There is a growing body of epidemiological research linking the diffusion of injecting drug use with concentrated outbreaks of HIV and hepatitis C in the region (Kurth et al., 2015, Matiko et al., 2014, Nyandindi et al., 2014). HIV prevalence estimates among PWID in Nairobi, Kenya, for example, have ranged between 14.5% and 50% (Kurth et al., 2015, NASCOP, 2014), and in Dar es Salaam, Tanzania, between 35% and 50% (Dutta et al., 2014, Nyandindi et al., 2014). While data is limited, estimates of hepatitis C prevalence among PWID in these settings appear higher still (Muasya et al., 2008, Nyandindi et al., 2014). There are few robust prevalence estimates of HIV, hepatitis C or tuberculosis among people who use drugs in West African and other Sub-Saharan African countries (Bouscalliou et al., 2016, Eluwa et al., 2013;Lancaster et al., 2016, Lepretres et al., 2015, Scheibe et al., 2016).