7 research outputs found
Monitoring quality and coverage of harm reduction services for people who use drugs : A consensus study
Background and aims: Despite advances in our knowledge of effective services for people who use drugs over the last decades globally, coverage remains poor in most countries, while quality is often unknown. This paper aims to discuss the historical development of successful epidemiological indicators and to present a framework for extending them with additional indicators of coverage and quality of harm reduction services, for monitoring and evaluation at international, national or subnational levels. The ultimate aim is to improve these services in order to reduce health and social problems among people who use drugs, such as human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection, crime and legal problems, overdose (death) and other morbidity and mortality. Methods and results: The framework was developed collaboratively using consensus methods involving nominal group meetings, review of existing quality standards, repeated email commenting rounds and qualitative analysis of opinions/experiences from a broad range of professionals/experts, including members of civil society and organisations representing people who use drugs. Twelve priority candidate indicators are proposed for opioid agonist therapy (OAT), needle and syringe programmes (NSP) and generic cross-cutting aspects of harm reduction (and potentially other drug) services. Under the specific OAT indicators, priority indicators included 'coverage', 'waiting list time', 'dosage' and 'availability in prisons'. For the specific NSP indicators, the priority indicators included 'coverage', 'number of needles/syringes distributed/collected', 'provision of other drug use paraphernalia' and 'availability in prisons'. Among the generic or cross-cutting indicators the priority indicators were 'infectious diseases counselling and care', 'take away naloxone', 'information on safe use/sex' and 'condoms'. We discuss conditions for the successful development of the suggested indicators and constraints (e.g. funding, ideology). We propose conducting a pilot study to test the feasibility and applicability of the proposed indicators before their scaling up and routine implementation, to evaluate their effectiveness in comparing service coverage and quality across countries. Conclusions: The establishment of an improved set of validated and internationally agreed upon best practice indicators for monitoring harm reduction service will provide a structural basis for public health and epidemiological studies and support evidence and human rights-based health policies, services and interventions
The complex relation between access to opioid agonist therapy and diversion of opioid medications: a case example of large-scale misuse of buprenorphine in the Czech Republic
Hepatitis C Virus Infection Epidemiology among People Who Inject Drugs in Europe: A Systematic Review of Data for Scaling Up Treatment and Prevention
Background: People who inject drugs (PWID) are a key population affected
by hepatitis C virus (HCV). Treatment options are improving and may
enhance prevention; however access for PWID may be poor. The
availability in the literature of information on seven main topic areas
(incidence, chronicity, genotypes, HIV co-infection, diagnosis and
treatment uptake, and burden of disease) to guide HCV treatment and
prevention scale-up for PWID in the 27 countries of the European Union
is systematically reviewed.
Methods and Findings: We searched MEDLINE, EMBASE and Cochrane Library
for publications between 1 January 2000 and 31 December 2012, with a
search strategy of general keywords regarding viral hepatitis, substance
abuse and geographic scope, as well as topic-specific keywords.
Additional articles were found through structured email consultations
with a large European expert network. Data availability was highly
variable and important limitations existed in comparability and
representativeness. Nine of 27 countries had data on HCV incidence among
PWID, which was often high (2.7-66/100 person-years, median 13,
Interquartile range (IQR) 8.7-28). Most common HCV genotypes were G1 and
G3; however, G4 may be increasing, while the proportion of traditionally
‘difficult to treat’ genotypes (G1+G4) showed large variation (median
53,IQR 43-62). Twelve countries reported on HCV chronicity (median 72,
IQR 64-81) and 22 on HIV prevalence in HCV-infected PWID (median 3.9%,
IQR 0.2-28). Undiagnosed infection, assessed in five countries, was high
(median 49%, IQR 38-64), while of those diagnosed, the proportion
entering treatment was low (median 9.5%, IQR 3.5-15). Burden of
disease, where assessed, was high and will rise in the next decade.
Conclusion: Key data on HCV epidemiology, care and disease burden among
PWID in Europe are sparse but suggest many undiagnosed infections and
poor treatment uptake. Stronger efforts are needed to improve data
availability to guide an increase in HCV treatment among PWID