A one-day refresher training program on OSB was conducted by the National Institute of Social Defence (NISD) and
Project H13 in Delhi on 16 April 2008. Participants at this training workshop were doctors, nurses, team leaders from seven NGOs partnering with the Project to carry out OSB with support from the National AIDS Control Organisation (NACO). The training was inaugurated by Mr. Satyendra Prakash, Director, NISD. Also present were Dr. Ravindra Rao, Programme Officer-TI (IDU) NACO and Dr. Rajat Ray, Professor and Chief, National Drug Dependence Treatment Centre (NDDTC)-AIIMS and his team.
(From left to right): Dr. Ravindra Rao, Programme Officer-TI (IDU) NACO, Dr. Rajat Ray, Professor and Chief, National Drug Dependence Treatment Centre (NDDTC)-AIIMS, Mr. Satyendra Prakash, Director, NISD and Ms. Harsheth Virk, Project Coordinator, Project H13, UNODC ROSA
The partner NGOs had been trained on OSB and its various components by the All India Institute of Medical Sciences (AIIMS) which is the Regional Learning Centre on OSB, in July 2007. At the time the participants were doctors, nurses, social workers and team leaders from 15 agencies including the Regional Resource and Training Centres (RRTCs) and their partner NGOs either implementing or going to implement OSB in the extended Phase I of the Project.
This was the first time that a meeting was held after the NACO takeover of OSB with the selected Oral Substitution (OS) sites of the project. The purpose of this workshop was for all the agencies to share their experiences, clarify any doubts, understanding the process of transition into a new phase of OSB and partnership with NACO.
Participants discuss issues of dosage and dispensing with the AIIMS team
At this meeting, Dr. Ravindra Rao, Programme Officer-TI (IDU) NACO spoke of where OST is placed in the NACP III and the vision of the IDU programme. He emphasized on the three tiers of harm reduction- outreach through Needle Syringe Programs, Oral Substitution and referral linkages to halt and reverse the HIV epidemic through care and support, strengthened service delivery and build capacity for service providers. He also spoke briefly of the specifics or guidelines of OSB under NACO such as client load for each centre, psycho-social services, dosage and regulation.
Mr. Satyendra Prakash, Director, NISD spoke on the composite comprehensive package of services for drug users that the project has been implementing and said that the idea was to be able to test and replicate this among other high risk populations. He mentioned that Project H13 has been able to demonstrate the empirical evidence of the success and efficacy of OS. He further highlighted that regarding OS, documentation was very critical to understand how the intervention is being rolled out and what gaps exists. This would also help in to see if there is a possibility of diversion and how it can be controlled. He congratulated the H13 and AIIMS team which pioneered and documented the whole process of OSB. Finally, he concluded by saying that OS can be used at a large scale and is a viable treatment option in India. He wished success and his support to the project in this endeavor.
Participants gear up for their presentations on their experiences with OSB so far
Dr. Rajat Ray, Professor and Chief, NDDTC-AIIMS spoke briefly on the rigorousness that needed to be maintained while inducting clients, fixing their dosage, tapering and administering the doses. These issues were discussed in detail by Dr. Anju Dhawan and the rest of the AIIMS team in the following sessions.
Each agency presented its experience with OSB so far, number and profile of clients reached, retention of clients, dosage given, type of staff in place, safekeeping and dispensing arrangements, timings of DIC, referral for medical problems and counseling. Interactive discussions were also held on recruitment of clients, intake assessment, retention and follow-up, streamlining reporting requirements, role clarity of project staff and drug procurement. The new formats for assessment of new clients, management of OSB, reporting formats along with the terms of reference and budgets were also discussed.
"The trainings on OSB held last July for the team leaders, doctors, nurses and social workers really helped us to manage the program. This current workshop now has refreshed our learnings and clarified our queries based on the experiences in implementing OSB in the last few months. We hope to even do a more skilled job."
Participants raised the concern on sustainable funding which can affect programme implementation, especially in terms of premature tapering of dose. Also, NGOs were urged to probe deeper into why the number of female clients for OSB was low and the drop out rate high even though a substantial number of female drugs users existed. Finally, it was agreed that more sensitization workshops for the drug law enforcement agencies, civil society and different stake holders in the community should be done for OS to be more widely accepted and implemented.