Invitation for proposals on Research Study: Continuum of Care (CoC) for Injecting Drug Users (IDUs

[Guest guest]

Population Foundation of India invites proposals on special study in

the field of HIV/AIDS on the theme ¡§Towards Developing a Model of

Continuum of Care (CoC) for Injecting Drug Users (IDUs), including

People living With HIV in Imphal, Manipur¡¨.

Institutions/Organisations having capacity and experience in

conducting research studies in the field of HIV/AIDS may submit a

detailed proposal and a cost estimate with organizational profile. A

brief concept note on the above theme is provided. Please send in

your proposals by e-mail to aparna@... before 25th March, 08

Concept Note

Towards Developing a Model of Continuum of Care (CoC) for Injecting

Drug Users (IDUs), including People living With HIV in Imphal,

Manipur

Background And Rationale

Manipur is one of the worst-affected states in Northeast India, with

a high HIV prevalence of about 70% among IDUs. Manipur lies adjacent

to the ¡¥Golden triangle¡¦, the area where borders of Myanmar, Laos

and Thailand meet. Thus, injecting and non-injecting recreational

drugs are commonly available in Manipur. According to a Rapid

Situation Assessment conducted in 2000, there were approximately

12667 IDUs in Imphal, Manipur¡¦s capital city. Studies have shown

very high risk behaviors among IDUs in Manipur with more than 90%

sharing needles and equipment. Also, HIV-positive IDUs in Manipur

have a very high prevalence of Hepatitis-B virus (HBV) (100%) and

Hepatitis-C virus (HCV) (92 to 98%).

Several models of continuum of care that are internationally

accepted are available for non-drug using people living with HIV

(PLHIV), including a toolkit for scaling up CoC in a particular

geographical area. There are some treatment models in relation to

drug-dependence treatment for IDUs and continuum of care models are

being developed in relation to the various treatment services for

alcohol/drug addiction, and substance abuse and mental health.

However, there are no continuum of care models for IDUs (including

those living with HIV) in relation to the various serice needs such

as HIV prevention and treatment, HBV/HCV prevention and treatment

and drug-dependence treatment services. The situation in Manipur

requires that any model of CoC for IDUs should also address

HIV/HBV/HCV-related services in addition to drug-dependence

treatment services

Models of Continuum of care can be seen as several levels: One is at

the institutional level ¡V whether a particular institution is

catering to the various service needs of a particular clientele. For

example, there is an institutional level care and support model from

SASO, Imphal, which is available for IDUs. The services provided by

SASO include: one-to-one interactions, group sessions with IDUs; STI

treatment (including partner treatment); counselling and information

on HIV prevention through counsellors and part-time doctors;

referral and linkages with various public healthcare services;

needle-syringe exchange programme (NSEP); training and capacity

building for community members; and oral substitution therapy (OST).

Though SASO provides several services, it does not (and could not)

offer all the services listed in the ¡¥comprehensive package

approach¡¦ of UNODC (see below). Obviously, it is virtually

impossible to have all the range of services needed for IDUs under

one roof.

Thus, even if an institution is offering a range of

services, it could not cater to the diverse needs of IDUs with

different characteristics (for example, HIV status, HCV/HBV status,

severity of substance dependence, etc.) and could not cater to all

IDUs in a city. Thus, at least one has to ensure that continuum of

care for IDUs is available within a city. This means that a full

range of services catering to all the needs of IDUs are available

within a city; with adequate coverage of the IDUs who need such

services; posing no barriers to IDUs; and well linked to other

services in that city through strong and effective referral

mechanisms. Once such a city level CoC model/action plan is

available, it would be easy for the state and federal government to

define what does CoC for IDUs mean and how to ensure that CoC for

IDUs are available in specific geographical areas.

While we currently do not have any CoC model at the city level, we

do have information about what should be the range of services

required for IDUs, including those with HIV. For example, UNODC

emphasizes the importance of having a ¡¥comprehensive package

approach for IDUs that include: outreach education; needle syringe

exchange programs; oral substitution treatment (sublingual

buprenorphine); ART and OI treatment for HIV-positive IDUs; drug-

dependence (de-addiction) treatment and rehabilitation programs;

abscess management; partners screening/treatment; and treatment for

co-infections (STIs, HBV, HCV, etc.)

During informal discussions with activists and NGO staff from

Manipur revealed the following in relation to the drug-related and

HIV/HBV/HCV-related medical and other services for IDUs in Manipur.

Lack of full range of services and treatment options for IDUs

Inadequate coverage of IDUs in the existing services and

Lack of effective referral mechanisms or linkages of

existing services for PLHIV

Lack of comprehensive and effective strategies for reducing

stigma and discrimination against drug users and people living with

HIV

All these short-comings mean that an integrated comprehensive and

continuum of care for IDUs is not available in Imphal, Manipur.

Consequently, these gaps can ultimately affect the effectiveness of

HIV prevention and drug dependence treatment programs for IDUs in

Manipur. Given the prevalence of HIV as 70 to 80% among IDUs in

Manipur, it is critical that any CoC for IDUs should also include

people living with HIV.

Thus, in order to ensure that IDUs (including PLHIV) in Imphal,

Manipur, have access to a range of services during various phases in

their drug careers and infections status (HIV/HBV/HCV), there is a

need for an integrated continuum of care at least at the city

level.

Objectives

To assess the current situation of the various drug- and

infection-related medical/non-medical services (Govt.

NGOs/CBOs/Networks, and Private sector) available for IDUs,

including ILHA, in Imphal, Manipur

To develop an action plan towards implementing an integrated

CoC for IDUs including PLHIV in Imphal

Expected Outcomes of the study:

As a result of this study we will know the following:

Identification of the unmet service needs for IDUs and ILHA

in Imphal

Extent of coverage of existing services and recommendations

to improve the coverage, if found inadequate;

Perception of service users about the quality of existing

services and suggest ways to improve the same;

Identification of barriers to access for existing services

and suggest ways to remove the same.

Identification of ways to create and strengthen effective

linkages among various existing services.

Availability of an action plan on how to implement an

integrated CoC for IDUs including PLHIV in Imphal.

All these will ultimately help in provision of an integrated

continuum of care for IDUs, including PLHIV in Imphal, Manipur.

" sonu8196 "

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