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Opioid Substitution Therapy for Injecting Drug Users: Scale versus Quality

Opioid Substitution Therapy for Injecting Drug Users: Scale versus Quality. WORKSHOP “OST in Developing Countries: A Primer” Atul Ambekar, Alok Agrawal (India). W e already know that…. Most effective treatment for opioid dependence - reduces illicit drug use and stabilizing life styles

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Opioid Substitution Therapy for Injecting Drug Users: Scale versus Quality

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  1. Opioid Substitution Therapy for Injecting Drug Users:Scale versus Quality WORKSHOP “OST in Developing Countries: A Primer” Atul Ambekar, Alok Agrawal (India)

  2. We already know that… • Most effective treatment for opioid dependence - reduces illicit drug use and stabilizing life styles • Works in variety of settings – hospitals, community, prison, etc. • Both available medicines (Methadone and Buprenorphine) work well • Known to reduce injecting and associated risky behaviours among PWID • Reduction in high risk sexual behaviours One of the 9 components of the comprehensive package of harm reduction services

  3. Intended scale of OST services • UN Target Setting Guide (2013) • Low coverage – up to 20% • Medium coverage – 20-40% • High coverage – more than 40% • Current worldwide coverage – about 8% (UN ref group on IDU and HIV, 2010) OST needs to be implemented at a large scale to accrue the benefits at a community level

  4. Implications for India • Estimated number of PWID – about 200,000 • HIV prevalence among PWID – 7.14% • Minimum OST Coverage • Medium – 40,000 • High – 80,000 • In 2010 • Number of PWID on OST – 3800 • Number of OST centres - 52 Need for massive scale-up of OST coverage across all regions and settings

  5. What we did…

  6. How quality is linked with scale-up… • Large proportion of OST slots unutilized – despite huge numbers recruited • Poor retention in treatment – most clients drop-out and go back to injecting • Low adherence to treatment – few clients benefit completely Any expansion of OST must take into consideration issues relating quality of services offered

  7. 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

  8. Thank You

  9. How quality is linked with scale-up

  10. Quality of services

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