Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
+ Opioid Substitution Therapy for Injecting Drug Users: Scale versus Quality WORKSHOP “OST in Developing Countries: A Primer” Atul Ambekar, Alok Agrawal (India) + 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 + 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) + 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 + 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 + 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 + 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 + Thank You How quality is linked with scale-up + 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 + 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