UNODC is cosponsor of the Joint United Nations Programme on HIV/AIDS - UNAIDS
Training Programme: Oral Substitution - Buprenorphine, 6 - 13 July 2007
Project H13: Prevention of Transmission of HIV among Drug Users in SAARC Countries
As a part of UNODCs 'Comprehensive Package Approach' (which includes a wide variety of measures aimed at reducing drug use), oral substitution treatment is being used as part of
Project H13 as an efficacious, safe and cost-effective modality for the management of opioid-dependence.
During Phase I, six standardised modules comprising, together, a comprehensive
Intervention Toolkit were developed . The modules are easy-to-use guides for NGO service providers and field workers to carry out risk reduction activities at the ground level. Two of these modules are on Oral Substitution, with Buprenorphine and with Methadone.
Dr. Suresh Kumar in interaction with participants during the OSB training Programme
The Joint Secretary, Ministry of Social Justice and Empowerment is the National Focal Point (NFP) for the project in India. The overall programme is being mentored by the National Institute of Social Defence (NISD) and the 8 Regional Resource and Training Centres (RRTCs). The All India Institute of Medical Sciences (AIIMS) has been designated as the Regional Learning Centre (RLC) for Oral Substitution Buprenorphine (OSB) by the NFP.
During Phase I of Project H13, OSB was carried out at 5 participating centers:
AIIMS (New Delhi)
SHARAN (New Delhi)
Calcutta Samaritans (Kolkata)
Presbyterian Hospital (Aizawl)
KEY FINDINGS OF OSB INTERVENTION (9 MONTH FOLLOW-UP):
68% retention rate of clients on Oral Substitution Buprenorphine
The current mean dosage was 3.8 mg
Drug use reduced significantly: from 27.8 days per month at baseline to 2.1 days per month at follow-up.
Injecting drug use reduced significantly: 52.8% respondents reported injecting at baseline and 28.5% at follow-up.
Among those injecting, both high risk injecting behaviour and high-risk sexual behaviour reduced
WHO Quality of Life Index and Addiction Severity Index Scores showed improvement for clients on Oral Substitution Buprenorphine.
EXTENSION OF PHASE I, INDIA
During the extended Phase I of the project, OSB is being scaled up from 5 sites to 15 sites. Of these 15 sites, 8 will carry out OSB as part of a comprehensive package of services and 7 will carry out 'stand alone' OSB interventions.
Rapid Situation and Response Assessment (RSRA), Peer Led Intervention (PLI), Safer Practices (SP), Low Cost Community Based Care and Support (LCCS) and Oral Substitution Buprenorphine (OSB)
Name of Agency
Trivandrum Social Service Society (TSSS)
Vishwa Jeevan Seva Sangha (VJSS)
Kripa Foundation - Kohima
OSB Stand Alone:
TRAINING PROGRAMME ON OSB (6-13 July 2007)
Following a sensitization workshop in November 2006, three training programme on OSB was organized for over 60 participants from the 15 partner agencies from 6-13 July 2007 in New Delhi. A team of trainers from AIIMS led by
Dr. Anju Dhawan conducted several participatory and useful sessions.
6-8 July 2007
Galaxy Club, Imphal;
KRIPA Foundation, Kohima
9-11 July 2007
SPYM, New Delhi;
SAHARA, New Delhi
12-13 July 2007
Presbytarian Hospital, Aizawl;
SASO, Imphal ;
SHARAN, New Delhi;
AIIMS, New Delhi
The first two training programmes from 6-8 July and 9-11 July were conducted for 10 new partner agencies which are going to carry out the OSB intervention under Project H13. The third training programme from 12-13 July was conducted for the 5 partner agencies that have been carrying out OSB intervention during the Phase I of the project. The focus of the latter training was on giving skills to NGO staff on how to shift the IDUs on Buprenorphine to a Buprenorphine-Naloxone combination and Naltrexone so as to achieve total abstinence
6-8 July 2007 The series of training programmes were formally inaugurated by
Dr. Arbind Prasad, Joint Secretary, Ministry of Social Justice and Empowerment, who is also the National Focal Point for the project in India. In his address, he expressed a need to scale up the interventions like OSB, to help reduce the transmission of HIV among the injecting drug users. He emphasized the need for establishing standardized protocols, which are evidence based, to help stem the epidemic. Also present on the occasion were
Mr. Satyendra Prakash, Director, National Institute of Social Defence,
Dr. Zeenat Naquatee, Secretary, FINGODAP,
Dr. Rajat Ray, Chief, National Drug Dependence Treatment Centre, AIIMS,
Dr. Anju Dhawan, National Drug Dependence Treatment Centre, AIIMS and
Ms. Ashita Mittal, Officer-in-Charge, UNODC Regional Office for South Asia.
9-11 July 2007 During the second training,
Dr. Jayadev Sarangi, Prison Expert, UNODC ROSA highlighted the issues concerning introduction of substitution therapy in closed settings.
Mr. C. R. Garg, D.I.G., Tihar Prisons, expressed his interest and enthusiasm towards introducing Oral Substitution Buprenorphine in the Tihar Prison in New Delhi and assured that safe keeping of medication would be done to avoid any possible diversion. He also suggested that a round table comprising prison officials, AIIMS and UNODC be held to initiate a pilot project in the Tihar prison.
Training Participants at the training from each of the agency included
Participants were given extensive training on the
concepts of substitution therapy, pharmacological protocols to carry out intervention, importance of psycho-social intervention in substitution therapy and role of clinical, psycho-social and laboratory assessments to help total recovery of the target population. Regional Support Persons (RSPs) from the respective RRTCs were also invited to the training programme to sensitize them towards the technical, logistical and other related issues to the intervention.
To facilitate better understanding, a practical hands-on-training was given to participants at De-addiction Centre (AIIMS), Trilok Puri, New Delhi and National Drug Dependence Treatment Centre (AIIMS), Ghaziabad, UP. Participants interacted with clients through one-to-one interviews and focus group discussions (FGDs). The participants also practiced filling up assessment questionnaires with clients, under the supervision of trainer team from AIIMS. Interaction with clients on OSB helped participants understand several related theoretical and practical issues of the intervention.
Dr. Suresh Kumar, Psychiatrist and an International Expert, helped trainees understand the concepts of substitution therapy, clarified issues of medical/technical nature and shared the global experience on OSB.
Mr. N. B. Mathur, Vice President, RUSAN Health Care clarified the logistics and medication-procurement issues in the country.
A participant's feedback
"Training provided me an in-depth understanding on the concept of oral substitution therapy (OST). At first I, myself, was a bit apprehensive of the OST approach; but having interacted with the clients on OSB and their family members, and having seen the outcome, I am pretty much convinced of the role of OST in total person recovery. I have also realized the undeniably important role of psycho-social intervention. Presence of doctor, nurse and social worker in the team would certainly help in overall rehabilitation of the client, in all the spheres of his life. I can now confidently deliver the intervention for my target population."