Download Opioid Substitution Therapy for Injecting Drug Users: Scale versus

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Opioid Substitution
Therapy for
Injecting Drug
Users:
Scale versus Quality
WORKSHOP
“OST in Developing Countries:
A Primer”
Atul Ambekar, Alok Agrawal (India)
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We already know that…
 Most
effective treatment for opioid dependence reduces illicit drug use and stabilizing life styles
in One
variety of
of settings
hospitals, community,
the 9 –components
prison, etc.
 Works
of the comprehensive
 Both available medicines (Methadone and
package of harm
Buprenorphine) work well
reduction services
 Known
to reduce injecting and associated risky
behaviours among PWID
 Reduction
in high risk sexual behaviours
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Intended scale of OST services
 UN Target
 Low
Setting Guide (2013)
OST needs to be
coverage – up to 20%
implemented
 Medium
coverage – 20-40%at a large
 High coverage
– more
than 40% the
scale
to accrue
benefits at a community
level
 Current worldwide coverage – about 8%
(UN ref group on IDU and HIV, 2010)
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Implications for India
 Estimated
 HIV
number of PWID – about 200,000
prevalence among PWID – 7.14%
Need for massive scaleof OST coverage
 Minimum OSTup
Coverage
 Medium – 40,000
across all regions and
 High – 80,000
settings
 In


2010
Number of PWID on OST – 3800
Number of OST centres - 52
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What we did…
200
22000
180
160
17000
140
120
12000
100
80
7000
60
40
2000
20
0
-3000
2009-10
2010-11
No of districts with OST
2011-12
2012-13
No of OST Centres
2013-14*
IDUs covered with OST
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How quality is linked with scale-up…
 Large
2010
proportion of
OST slots unutilized –
2500
Any
expansion
of
OST
despite huge numbers
3800
recruited
must take into
consideration
issues
retention
in
treatment – most
relating
quality
of
clients drop-out and
services offered
go back to injecting
 Poor
 Low
adherence to
treatment – few clients
benefit completely
4800
9000
OST slots
PWID registered in OST
PWID currently on OST
PWID taking OST regularly
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OST implementation: learning from
Indian Experience
 Scale-up
should be planned and phased with
priority areas and populations well-defined
 Necessary
to build sufficient local experience and
expertize with the intervention while attempting
expansion
 Critical
to focus on quality of service delivery in
parallel
 Multiple
mechanisms for quality assurance should
be incorporated into the system
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Thank You
How
quality
is
linked
with
scale-up
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2010
OST slots
PWID registered in
OST
PWID currently on OST
2014
PWID taking OST
regularly
OST slots
PWID registered in
OST
PWID currently on OST
PWID taking OST
regularly
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Quality of services
Independen
t evaluation
SOPs and
operation
al
guideline
s
Quality
assurance
mechanism
s
Accreditati
on for
quality
Regular
reports
contributing
as inputs for
improvement
Standardize
d training
tools
Monitorin
g and
handholding by
field staff