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HIV & AIDS and Drug Use in Bangladesh

HIV & AIDS and Drug Use in Bangladesh. Dept. of Narcotics Control (DNC), Ministry of Home Affairs National AIDS/STD Program (NASP), Ministry of Health and Family Welfare Icddr,b UNODC ROSA. GENERAL INFORMATION. Numbers of PWID in Bangladesh – 20,000- 40,000

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HIV & AIDS and Drug Use in Bangladesh

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  1. HIV & AIDS and Drug Use in Bangladesh Dept. of Narcotics Control (DNC), Ministry of Home Affairs National AIDS/STD Program (NASP), Ministry of Health and Family Welfare Icddr,b UNODC ROSA

  2. GENERAL INFORMATION • Numbers of PWID in Bangladesh – 20,000- 40,000 • Numbers of female PWID – not known • Estimated number of HIV infected PWID - 444

  3. HIV PREVALENCE IN PEOPLE WHO USE DRUGS, 2011 (source: 9th round HIV serological surveillance, NASP) 7529 PWUD sampled from 30 cities HIV found in five cities only

  4. SYPHILLIS PREVALENCE AMONG PWUD, 2011 (source: 9th round HIV serological surveillance, NASP) Note: Combined PWID/HS refers to the combined group of PWID and heroin smokers. Numbers in brackets refer to the total numbers of PWUD sampled in each city

  5. HARM REDUCTION SERVICES AVAILABLE IN BANGLADESH, 2012

  6. Phase II of Project RAS/H13 in Bangladesh: an Overview Focal Agencies: DNC and NASP Services for females who use drugs (FPWUD) and Female Regular Sex Partners (FRSPs) of male PWUD Implemented by four PNGOs: APON, CREA, DAM and Light House Mentor agency: icddr,b Duration: December 2007 to October 2011 Opioid Substitution Therapy (OST) Implementer and technical agency: icddr,b Duration: March 2010 - ongoing.

  7. Intervention areas of PNGOs in Bangladesh Intervention area for OST Central Drug Addiction Treatment Centre (CTC) under the DNC in Dhaka

  8. CAPACITY BUILDING OF PNGOs • Training – 15 events • Basic training on HIV and AIDS • STI – Prevention, transmission and treatment • Positive Living • Drug counselling • Detoxification and abscess management • Rapid Situation and Response Assessment (RSRA) • Cross visits (exchanging experience and knowledge among PNGOs)-16 • Monthly monitoring visit • Quarterly coordination meeting

  9. Harm reduction services for Female PWUD and Female Regular Sex Partners of Male PWUD • Peer Led Intervention provided through Drop in Centres and outreach: • Condom promotion and distribution - 1,66,216 • STI management through part time doctor and paramedics – • 1,051 STI cases • Counseling - 2,202 sessions • Enhancing awareness on HIV for safer practices - ~350 sessions • Low-cost community detoxification services (15 days) – 93 Female PWUD from 6 detox-camps • Community sensitization/advocacy meetings- 73 • Support group formation – 14 • VCT - 448 (through referral to Jagori, icddr,b)

  10. Numbers of Beneficiaries Note: in 2009, 83 male PWUD also covered (optional) in Gazipur in 2011, services were provided up to October 2011

  11. Some special services and materials (2008-2011) • In some of the sites in Gazipur (DAM) and Natore (Light House) satellite services were provided to those living far away from the DICs • 3 female PWUD and FRSP of male PWUD focused BCC materials developed and printed • Reproductive health services – Pregnancy test, prophylactic therapy during ANC and referred for X-ray, ultra-sonogram and safe delivery

  12. RSRAs Baseline (N=137) Midline (N=214) Two RSRAs were conducted in Phase II: • First RSRA - with females who use drugs (FPWUD) and female regular sex partners (FRSPs) of male PWUD at the beginning of Phase-II (in 2007) • Second (Midline) RSRA – among the same groups in 2010 % * p<0.05, **p<0.01

  13. WHAT HAS HAPPENED AFTER OCTOBER 2011 • Female PWUD in Hajaribagh, Dhanmondi, Katashur and Mohmmadpur Beribad areas of Dhaka (CREA & Apon) are receiving services from Modhumita project of fhi360 and CARE Bangladesh’s DICs • Female PWUD who sell sex in Gazipur (DAM’s area) and who are close to World Vision’s STI clinic are receiving STI services from World Vision • Female PWUD of Mohammadpur, Agargaon (BNP slum) of Dhaka (part of Apon’s area) and Natore (Light House’s area) are not covered by any harm reduction programmes • No services are available for female regular sex partners of male PWUD

  14. Opioid Substitution Therapy (OST) Pilot in Dhaka, Bangladesh

  15. Overview of the OST Pilot Study Approved by the National Narcotics Control Board in August 2008 as a pilot using methadone Focal Agencies of the Government of Bangladesh: Department of Narcotics Control (DNC) and National AIDS/STD Programme (NASP) Supported by: UNODC and fhi360 Implementing and technical agency: icddr,b Overall guidance provided by the National Steering Committee Technical guidance provided by the Coordination Committee

  16. OST Using Methadone • Establishment of one MMT centre at CTC • Opened on 8 July 2010

  17. Methodology Inclusion criteria: • ≥18 years • opioid dependent for at least 5 years • currently injecting drugs (at least for the last one month) • two failed abstinence attempts • willing to participate • Enrolled PWID receive transport fare of Tk. 50 (~US$ 0.68) for each visit • Urine tests for opioids and Benzodiazepines are conducted routinely every quarter and when clinically suspected So far 163 clients enrolled Of these 6 are HIV positive and 4 are on ART 102 opted for VCT

  18. Retention rate among 150 clients and reasons for drop out Between July 2010 and April 2012 among 150 clients enrolled, 27 dropped out (retention rate 82% ) Number of cases

  19. Methadone dosage “START LOW AND GO SLOW” • Initial phase: • Lowest dose - 10 mg • Highest dose - 30 mg • Average dose - 15 mg • Maintenance phase: • Lowest dose - 20 mg • Highest dose – 165 mg • Average dose - 50 mg • Discontinuation phase: 12 PWID

  20. Data collection • Every quarter • Data is collected using questionnaires • Risk behaviour • Depression, Anxiety and Stress Scale (DASS-21) • Leeds Dependence Questionnaire (LDQ) • WHO Quality of life (WHOQOL-BREF) scale • Clinical assessment

  21. Analysis of data for the first two quarters (six months after enrollment) has been conducted on 129 clients Baseline : 8 July 2010 to 3 April 2011 1st quarter : 28 October 2010 to 5 July 2011 2nd quarter: 27 February 2011 to 5 October 2011

  22. Demographic profile at baseline (N=129)

  23. Major sources of income (N=129) * p<0.001 NB:† p value is not calculated

  24. Living status and marital satisfaction Baseline (N=67) 1st Quarter (N=69) 2nd Quarter (N=79) % Marital satisfaction (among those who are married) Current living status * p<0.01; **p<00.05

  25. Experienced depression (N=129) % in the last three months Level of depression on DASS-21҂ scalein the last month NB: ҂ Depression Anxiety and Stress Scale (DASS-21) *p<0.01; **p<0.001

  26. Quality of life on WHOQOL BREF Scale (N=129) Mean Scores *p<0.001

  27. Methadone Anonymous (MA) Meeting • Three MA groups formed in three different areas of Dhaka • Since June 2011, fortnightly MA meetings are being conducted

  28. AcknowledgementAll beneficiaries and participants Self help groups of PWUDDNCNASPUNODCfhi360 THANK YOU

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