Opioid Substitution Therapy - A Government Scheme in five districts of Punjab

[Guest guest]

Injecting Drug Users (IDU) are highly vulnerable to HIV transmission in India.

It is estimated that prevalence rates of HIV in injecting drug users in the

country is 9.1% (The 2007 HIV Sentinel Surveillance figures is 7.23%.

However, recent figures indicate a rate of 9.16%), with considerable

variation between sites and states. The National AIDS Control Organisation,

NACO, has given priority to up-scaling harm reduction strategies in the National

AIDS Control Programme III, which are implemented mainly through targeted

Interventions (TI) by NGOs.

Significantly, the harm reduction approach in the national programme has

intensified over the last few years.

Harm reduction services focus on safer injecting and sexual behaviours and

include Needle Syringe Programmes, abscess prevention and management, referrals

for health care, condom distribution and Behaviour Change Communications.

Since 2008, an important development in the harm reduction strategy of the

national programme has been the inclusion of Opioid Substitution Therapy (OST).

Moreover, in the continuum of harm reduction the provision of OST is a key

intervention from needle exchange and safe injecting towards eventual cessation

from any injecting behaviour.

There are 50 NACO accredited OST sites in the country and the targeted

intervention protocols for IDU services now include OST operational guidelines.

The national AIDS programme plans to cover 40,000 injecting drug users through

OST services by 2012, and the coverage target for 2010 is 10,000 IDUs.

However, so far approximately 4,840 IDUs have been reached through OST

interventions.

NACO is keen to rapidly increase the coverage of OST interventions in the

country and has strategically decided to increase intervention coverage by

setting up OST services in government hospitals and other public health care

settings. This approach would supplement the OST services provided in

communities through targeted intervention projects managed by non-governmental

organisations (NGOs).

The state of Punjab has been selected to initiate the OST government scheme. The

selection of Punjab results from the high HIV prevalence rates amongst IDUs in

the state. It is estimated that 26% of the approximately 20,470 IDU in the state

are infected with HIV.

There are also reports that the high mobility of this population increases the

vulnerability of their sexual partners to HIV infection. The districts of

Amritsar, Ludhiana and Ropar in particular are affected. This endeavor seeks to

reduce injecting driven HIV epidemic amongst IDU in the five districts.

NACO aims to implement OST services through district civil hospitals for IDU in

5 districts in Punjab namely Amritsar, Batala town in Gurdaspur, Jalandhar,

Ludhiana and Tarn Taran.

This selection was based on the criteria of IDU prevalence, HIV prevalence, and

coverage of IDU by the TI NGO and distance to the government health care

facility. In the first year of its implementation 100 IDU will be enrolled at

each government run OST center totaling 500 IDU on OST in the five districts.

The DFID Technical Assistance Support Team (TAST) is assisting NACO in setting

up these centers in close coordination with Punjab SACS.

In the last week from Aug 2 - 6, 2010, training on OST with Buprenorphine was

conducted at Chandigarh STRC by NDDTC AIIMS. The newly recruited OST staff from

the health care facility Nodal Officers, Doctors, Nurses, Counselors & Program

Managers and Outreach workers from the TI NGO from three districts, Amritsar,

Ludhiana and Tarn Taran attended this five day training program. The second

phase of the same training for the remaining staff from Jalandhar and Batala is

scheduled in the forthcoming week from Aug 16 - 20, 2010.

Subsequently, a training manual on OST implementation has been developed by

NDDTC AIIMS which was pre-tested during this training and will be finalised

after testing it for the second time.

--

Francis ph

DFID AIDS Technical Assistance Support Team (TAST)

Futures Group International India Pvt. Ltd.

5th Floor, Building No: 10B

DLF Cyber City, Phase II

Gurgaon, Haryana

francjoseph@...

fjoseph@...

Mob: +91 971 745 61 95

Direct: 0124 4702071

Skype: francisjoseph21

[Guest guest]

Dear all,

In response to “Opioid Substitution Therapy - A Government Scheme in five

districts of Punjab”.

/message/11832

Over a decade of Harm Reduction program in the state, HIV prevalence

has come down in Manipur from 90% to 17% amongst the PWID populace

although it still is very high comparing to other states where

Manipur is having a population of just 23 lacs as per the 2001 census.

Being from the drug using community, I would like to appreciate NACO’s

initiative in tackling the HIV epidemic among the people who inject drugs and

would also like to personally convey my gratitude to all the dedicated NGO’s

and CBO’s especially those funding agencies like European Commission, DFID &

UNODC for their initiative in implementing the program way back in 1999 and

2006 in the state of Manipur.

And as a resultant of a series of consultation and Advocacy undertaken by the

EHA & local partner NGOs to NACO since 2007, the program has been scaled up by

NACO in a very low profile manner and in partnership with local CBOs, NGOs

targeting approximately 1400 PWID covering only a few sites.

The UNESCO RSA, 2000 report clearly estimates that PUD populace to be around

14,000 of which 98% are of injecting practices

and this estimation does not cover the whole state but rather the twin capital

district of Imphal.

It is heartening to learnt that NACO plans to scale up OST services

covering 40,000 People who Inject Drug by the year 2012 for the whole

country. And yet while scaling up the OST program in the country, NACO must

properly take into consideration the drug using scenarios from a local

perspective since what applies in a state cannot photocopy what works in

another state.

The point is what works in Punjab cannot be termed as viable for a state like

Manipur where the cultural context, injecting rituals or the atmospheric set-up

in an armed conflict state like Manipur contrasted with other states as drug

using scenario are

quite different compared to Northeast region and other mainland India.

With due respect to the drug using populace, I am just trying to

highlight the hard facts or the ground realities, wherein the other

state or cities, the PUD populace are easily visible and hence very

easy to operationalised OST in the Govt. set up. However, I do have my own

apprehension of this strategy being feasible in the Northeast context.

I also sincerely believed that since EHA has been implementing OST

program in the NE region they do have the responsibility of Advocating NACO

before scaling up widely in the country in terms of adequate coverage by

addressing local specific needs.

Before making a decision that could impact the larger populace of PUD, I would

like to put up some food for thoughts for the members so that all could have a

vivid idea on the way forward.

Is the NACO & Govt. set up really equipped to handle the sensitive

needs of PUD community ( e.g, rights violation from pressure group and

compromising confidential issues)?

Does the Govt. sector have the adequate infrastructure and capacity to deal

with the issue( not just the NABH accreditation but the holistic approach)?

What about the extra miles that the NGOs provider transcend in

delivering services such as follow-up, quality counseling, psycho-

social support, monitoring, home visits and reaching out to hidden/

underground populace of PUD( will the PUD community able to identify

with Govt. providers)?

Have the decision makers taken into account the lackaidasical attitude/culture

of Govt. employee’s?

We have a typical work culture of Govt. employees in the country where one and

all understand the red tapism.

Is the policy makers contented with the roll-out policy of just

providing a dose under the tongue without addressing the accessibility factors

and psychological/physical needs of the concerned beneficiaries?

The current OST programme would be more meaningful if the

beneficiaries could rehabilitate themselves in true sense like

mainstreaming the PUD in terms of employment, health seeking

behaviour, and ultimately getting rid of dependency for no PUD would

like to see themselves bonded?

OR in any case if NACO is considering the issues on diversion of

Medicine, so far the evidential experiences from NGOs provider does

not reflect any such instances/incidences.

Best Regards,

Bangkim Chingsubam

Imphal.

e-mail:<cbangkim@...>