Understanding, Planning and Managing Outreach

1. Understanding, Planning and Managing Outreach

2. “Outreach is a systematic approach to delivering HIV prevention services to people injecting drugs in their environments”

3. Why Outreach? • Injecting drug use is illegal and not socially approved • IDUs are stigmatised by self, service providers and society • IDUs are preoccupied and not able to focus on other needs • IDUs remain hidden and do not seek services • Conventional service delivery approaches have not been effective • Majority of IDUs not ready to accept responsibility for their own HIV prevention • Outreach service more acceptable to IDUs in addressing their needs • HIV prevention requires rapid and wide-scale coverage within shortest possible time • Outreach often links IDUs with other services-TB,STI, ICTC, ART

4. Objectives of Outreach • Overall Objective: To prevent transmission of HIV & other blood-borne viruses among IDUs • Specific Objectives: • To ensure IDUs have easy access to and utilise available services • To ensure significant reduction in needle sharing and unsafe sexual contact • To prevent drug use related harms • To mobilise the IDU community

5. Services Provided Through Outreach • Education, advice, information on • Risks of HIV, HBV/HCV, STIs and means of reducing risks • Safer injecting & safer sex practices • Prevention and management of overdose & abscess • Services available for • STI diagnosis and treatment • HIV testing • ART • TB Contd…

6. Services Provided Through Outreach • Distribute the following commodities regularly, as per need of the IDUs and their regular sex partners: • New needles and syringes • Abscess prevention materials such as alcohol swabs, distilled water etc. • Condoms – free as well as socially marketed • IEC materials, as and when required • Collect used/old needles and syringes • Provide referral services to appropriate healthcare and other agencies

7. The Team • PE • IDU • PE • IDU • ORW monitoring managing planning Conducting • PE • IDU • PM • PE • IDU • ORW • PE • IDU • PE • IDU

8. Outreach Involves

9. Objectives of Planning • Identify the number of IDUs at each site • Estimate required risk reduction materials (like N/S and condoms) for adequate and uninterrupted supply • Facilitate effective individual tracking vis-à-vis service access and behaviour modification • Collect information for effective action plans • Enhance participation of IDUs in program planning • Identify and monitor problem areas for improved service

10. Key Questions to Consider • How many IDUs are there in the target area? • Can we reach all? • How many regular injectors are there in the IDUs? • Can we meet them according to their accessibility rather than on the basis of their risk/vulnerability? • How many N/S or condoms do we need in a month to cover risk occasions? • Does the outreach timing suit the IDUs? • Can we track each individual?

11. Outreach Planning

12. A Social Map

13. 1. Social Map • A social map is a rough diagram of the intervention area • Shows overview of the sites/areas where IDUs gather (hotspots) and can be accessed • Shows service points such as hospital/NGO/clinics/referral health care, condom supply, ICTC, ART, STI, TB etc. • Purpose – establish a dynamic understanding of IDUs for complete coverage through Outreach in the project site • Map to be drawn by IDUs, PEs led by ORW

14. Developing a Social Map • Social mapping can be conducted as either a field or DIC activity by PE and ORW involving (IDU). The PM can act as facilitator in the process • Social map should be updated regularly • Inclusion of IDUs will ensure their views and wisdom are represented since they are better informed than outsiders

15. 2. Spot Analysis • Provides number of IDUs in a particular spot according to their: • Time of availability • Age • Type of drugs injected • Frequency of injecting • daily injectors (at least one injecting episode per day) • non-daily injectors (less than one injecting episode per day) • To be conducted by PEs supervised by ORWs Contd…

16. 2. Spot Analysis

17. 3. Contact Mapping • Questions: • How many contacts in each spot? • In which spot are the contacts limited? • What are the reasons for limited contacts? • What should be done in locations where contacts are limited? • Is there a duplication of names in the contact list? • Helps in planning coverage and reaching services to individual IDUs • Conducted by PE and facilitated by ORWs Contd…

18. 3. Contact Mapping

19. 4. Risk/Vulnerability Assessment • The ORW / PE should collect the following information from each IDU The risk/ vulnerability parameters should, at the minimum, include: • Types of drug injected • Frequency of injection • Sharing of N/S or other injecting equipment • Sexual behaviour: frequency of sexual intercourse, protected /unprotected sex • Sensitivity about disclosure (to family/ others about their drug use/sex work)

20. Outreach Plan • Outreach plan is developed using spot analysis, social mapping, contact mapping and risk and vulnerability analysis • Plans a weekly target for outreach to the IDUs of each area (hotspot) • Weekly plan for each PE can be different as per the variation in needs, spots, risks and vulnerabilities. • Should vary from week to week depending on the service uptake/ outreach patterns • Should tie into other activities designed to increase IDU engagement or service utilization • Is led by the ORW and monitored by PM

21. Conducting Outreach Step 1: Building rapport with the IDU and the general community Step 2: Delivering services in the field; referrals to DIC and other services Step 3: Creating enabling environment Step 4: Documentation and Analyses

22. Services Provided in Outreach • Needle Syringe Exchange Program (NSEP) • Behaviour Change Communication (BCC) • Condom Promotion • Referrals • Creating enabling environment

23. Monitoring • Field level: ORW with the PEs • TI level: PM with ORWs and PEs

24. What to Monitor • Coverage as per target and plan • Reaching out to identified population as per plan • N/S supply as per calculated demands • Other provisions (cotton swab, distilled water- as planned by TI) for safer injecting • Condom supply as per calculated demand • Referral to DIC • Follow-up on referrals • BCC at the field level • Documentation

25. Monitoring Through Field Visits • PM should visit the hotspots two to three times a week, some may be surprise visits • During the visits the PM should be meeting: • Some IDUs • Some stakeholders (local- tea, paan sellers, pharmaceutical shop owners/staff, community leaders/key influencers, police etc.) • The PEs and ORWs working in the hotspot

26. Monitoring Through Document Review The following records/documents should be reviewed every fortnight: • Outreach plan including spot analysis • N/S stock register • DIC registration records • DIC service utilisation registers • PE weekly planning & activity sheet (Form B1 for IDUs) • PE-wise individual HRG sheet compiled for IDU intervention (by ORW) (Form C) • Monthly CMIS report

27. Monthly Review Meeting • The PM should also conduct review meetings at the DIC with the ORWs at least once in a fortnight • During the review meeting the PM should base the discussion on his/her findings from: • Field visit • Record/documentation review • ORW-PE field level

28. Roles and Responsibilities of PM • Ensure: • Outreach team conducts outreach planning • Outreach team meets on a weekly basis updating on the previous week and planning for the coming one • Enough commodities are available at the DIC/NGO office for outreach activities • A backup plan for outreach staff taking leave/being absent • Vacancies due to staff drop-outs are filled up • Set up a routine monitoring mechanism for supervision • Monitor the outreach activities • Build the capacity of the outreach team

29. Thank You !!