scale-up of ost services under the national aids control programme how is india doing it? workshop...
TRANSCRIPT
Scale-up of OST services under the National AIDS Control Programme
How is India doing it?
WORKSHOP“OST in Developing Countries:
A Primer”Atul Ambekar, Alok Agrawal (India)
Contents
Background: PWID-HIV situation in India
OST service delivery models
Capacity Building, Monitoring and Quality Assurance of OST
PWID – HIV situation in India
• Estimated PWID
~ 200,000~ 95% male~ 8% living with HIV
• Heterogeneity of epidemic – ‘Old’ versus ‘New’
epidemics – Drugs injected: Heroin /
Brown Sugar; Buprenorphine, Pentazocine, D-propoxyphene
– Wide variations in sero-positivity (1% to 50%)
OST in India
• Buprenorphine for treatment of Opioid dependence – In existence since 1989– At a smaller scale
• OST as HIV prevention intervention for PWID– Since 2007 – Undergoing scale–up
OST scale-up in India - Buprenorphine
Year 2007-10 Year 20140
2000
4000
6000
8000
10000
12000
14000
16000
3000
15000
Number of PWID on OST
Year 2007-10 Year 20140
20
40
60
80
100
120
140
160
51
150
Number of OST centres
OST scale-up in India - Methadone
• Initiated as a Pilot Project – 2012 – 5 sites, all government hospitals – About 600 PWID initiated on Methadone – On the verge of scale-up
2010: The Watershed year
• Introduction of new model of OST service delivery
HOSPITAL
NGONGO
OLD MODEL OF OST SERVICE DELIVERY
PWID
NSEP and other Harm reduction services
OST services Other Health services
NEW MODEL OF OST SERVICE DELIVERY
HOSPITAL with OST
NGONGO
Outreach worker from NGO takes PWID to the OST center in govt. hospital
PWID
NSEP and other Harm reduction services
Mechanisms for Capacity Building on OST
1. Induction Training 2. Quality assurance3. Accreditation
Mechanisms for building capacities and ensuring
quality
1. Induction Training
2. Quality Assurance / Mentoring
3. Accreditation
Capacity Building
Evaluation
Mechanisms for building capacities and ensuring
quality
1. Induction Training
2. Quality Assurance / Mentoring
3. Accreditation
Capacity Building
Evaluation
Induction Training on OST0A five day training programme 0Conducted soon after recruitment of staff 0Conducted for a mixed group of staff (nodal officers,
doctors, nurses, counselors, data managers, programme managers and outreach workers)
0Class-room type training 0 Highly interactive and participatory 0 Exposure visit – an essential component
0BASED UPON A MANUAL 0Outcome:
0 Trained staff who begin service delivery after receiving a certificate
Mechanisms for building capacities and ensuring
quality
1. Induction Training
2. Quality Assurance / Mentoring
3. Accreditation
Capacity Building
Evaluation
Quality Assurance of OST
0 In the form of ‘visits’ by OST experts / mentors 0 Visits aimed at:
0 Assessment of the quality of services0 Interaction with and guidance to the staff on ensuring
adequate quality 0 Mentors / experts: Doctors; experience / expertise in
OST; trained on QA guide0 Outcome: Staff receives hands-on guidance; SACS /
NACO receive a report on performance
Quality Assurance of OST
0 In the form of ‘visits’ by OST experts / mentors 0 Visits aimed at:
0 Assessment of the quality of services0 Interaction with and guidance to the staff on ensuring
adequate quality 0 Mentors / experts: Doctors; experience / expertise in
OST; trained on QA guide 0 Outcome: Staff receives hands-on guidance; SACS /
NACO receive a report on performance
Atul Ambekar, Ravindra Rao, Alok Agrawal, Anju Dhawan, Rajat Ray, (2013), Quality Assurance of OST in India: A reference guide for mentors, NDDTC, AIIMS and NACO, Government of India, New Delhi
QA Guide: Contents
0 Introduction / About the Reference Guide 0 Conducting a Quality Assurance Visit0 Preparing a Quality Assurance Visit Report0 Tool for OST Quality Assurance Visit0 OST Quality Assurance Visit Report - Proforma0 Annexures: List of common problems and their
solutions; Steps for Planning and Managing QA Visits,
Conducting a QA visit0 Inform the centre staff and concerned SACS prior to visit 0 During visit
0 Observation of the centre, including functioning of the staff and service delivery processes
0 Review of records0 Interaction with
0Staff – OST centre 0Staff – linked IDU TI 0Beneficiaries0Other stakeholders
0 Use the prescribed format to conduct the visit 0 Use the prescribed format to report the visit
Tool for OST quality assurance visit
Section 1: Background information
Section 2: Details of the OST centre
Section 3: Staff-related Details
Section 4: Implementation Of OST
Section 5: Record Keeping-related Details
Section 6: Feedback from Clients and their Families
Section 7: Stock Maintenance & Programme Management
Section 8: Gaps Identified and Addressed
Section 9: Impression on Quality of OST Centre
Tool for OST quality assurance visit
Impression on Quality of OST centre
016 - item scoring scale 0Each item can be scored 1, 2 or 3 0Option for giving remarks for each item0Quality grading depends upon the total %
score obtained
Item 1: OST uptake
Item 2: Recruitment and training of staff
Item 3: Knowledge and confidence of staff on OST issues
Item 4: Role clarity
Item 5:Initial assessment of clients before OST initiation
Item 6: Stabilisation dose of buprenorphine
Item 7:Follow-up of OST clients
Item 8:Changes in dose of buprenorphine
Impression on Quality of OST centre
Item 9:Duration of maintenance phase of treatment
Item 10:Follow-up of LFU/irregular clients in the field
Item 11:Dispensing-related protocols
Item 12:Record maintenance
Item 13:Stock management
Item 14:Satisfaction of clients and family members
Item 15:Client retention
Item 16: Treatment adherence and compliance
Impression on Quality of OST centre
OST Quality Assurance visit report
0Observations/findings and specific recommendations on specific areas of OST implementation
0Other specific inputs provided0Issues for consideration by
programme authorities
Annexures
0List of common problems and possible solutions
0Planning and managing the OST QA visits
Mechanisms for building capacities and ensuring
quality
1. Induction Training
2. Quality Assurance / Mentoring
3. Accreditation
Accreditation 0 All NGO OST centres expected to undergo Accreditation
0 Accreditation for Government centres also on the anvil 0 Conducted by an independent agency: National
Accreditation Board for Hospitals (NABH) 0 Through trained team of two experts (Technical +
Programme) 0 Using a especially prepared tool
0 Report provides 0 Scores0 Qualitative / descriptive information
Accreditation 0 All NGO OST centres expected to undergo Accreditation
0 Accreditation for Government centres also on the anvil 0 Conducted by an independent agency: National
Accreditation Board for Hospitals (NABH) 0 Through trained team of two experts (Technical +
Programme) 0 Using a especially prepared tool
0 Report provides 0 Scores0 Qualitative / descriptive information
The Accreditation Tool0 In the form of an excel sheet 0 Filled by both the experts through observations and
interaction
The Accreditation Tool0 In the form of an excel sheet 0 Filled by both the experts through observations and
interaction0 Sections
0 Infrastructure 0 Staff 0 Service Delivery Process 0 Performance 0 Qualitative information 0 “Essential Items”
Accreditation: Essential items Infrastructure Storage of Medications
Staff DoctorOST Nurse
OST Service Delivery Processes
Regularity of functioningAdherence to DOTSDosage ChangeDispensing RecordsStock recordsMechanisms to check diversion
Programme Performance Service utilization
Resource Materials developed for Capacity Building and Quality Assurance
1. Training Manual
2. SOPs 3. Practice Guidelines
4. QA Guide
Thank you