Scale-up of OST services under the National AIDS Control Programme

1. Scale-up of OST services under the National AIDS Control Programme How is India doing it? WORKSHOP “OST in Developing Countries: A Primer” Atul Ambekar, Alok Agrawal (India)

2. Contents

3. PWID – HIV situation in India • Estimated PWID ~ 200,000 ~ 95% male ~ 8% living with HIV • Heterogeneity of epidemic • ‘Old’ versus ‘New’ epidemics • Drugs injected: Heroin / Brown Sugar; Buprenorphine, Pentazocine, D-propoxyphene • Wide variations in sero-positivity (1% to 50%)

4. OST in India • Buprenorphine for treatment of Opioid dependence • In existence since 1989 • At a smaller scale • OST as HIV prevention intervention for PWID • Since 2007 • Undergoing scale–up

5. OST scale-up in India - Buprenorphine

6. OST scale-up in India - Methadone • Initiated as a Pilot Project – 2012 • 5 sites, all government hospitals • About 600 PWID initiated on Methadone • On the verge of scale-up

7. 2010: The Watershed year • Introduction of new model of OST service delivery

8. OLD model of OST service Delivery  OST services Other Health services NGO HOSPITAL NSEP and other Harm reduction services PWID

9. NEW model OF OST Service Delivery  Outreach worker from NGO takes PWID to the OST center in govt. hospital NGO HOSPITAL with OST NSEP and other Harm reduction services PWID

10. Mechanisms for Capacity Building on OST Induction Training Quality assurance Accreditation

11. Mechanisms for building capacities and ensuring quality Capacity Building Evaluation

12. Mechanisms for building capacities and ensuring quality Capacity Building Evaluation

13. Induction Training on OST • A five day training programme • Conducted soon after recruitment of staff • Conducted for a mixed group of staff (nodal officers, doctors, nurses, counselors, data managers, programme managers and outreach workers) • Class-room type training • Highly interactive and participatory • Exposure visit – an essential component • BASED UPON A MANUAL • Outcome: • Trained staff who begin service delivery after receiving a certificate

14. Mechanisms for building capacities and ensuring quality Capacity Building Evaluation

15. Quality Assurance of OST • In the form of ‘visits’ by OST experts / mentors • Visits aimed at: • Assessment of the quality of services • Interaction with and guidance to the staff on ensuring adequate quality • Mentors / experts: Doctors; experience / expertise in OST; trained on QA guide • Outcome: Staff receives hands-on guidance; SACS / NACO receive a report on performance

16. Quality Assurance of OST • In the form of ‘visits’ by OST experts / mentors • Visits aimed at: • Assessment of the quality of services • Interaction with and guidance to the staff on ensuring adequate quality • Mentors / experts: Doctors; experience / expertise in OST; trained on QA guide • Outcome: Staff receives hands-on guidance; SACS / NACO receive a report on performance

17. Atul Ambekar, Ravindra Rao, Alok Agrawal, Anju Dhawan, Rajat Ray, (2013), Quality Assurance of OST in India: A reference guide for mentors, NDDTC, AIIMS and NACO, Government of India, New Delhi

18. QA Guide: Contents • Introduction / About the Reference Guide • Conducting a Quality Assurance Visit • Preparing a Quality Assurance Visit Report • Tool for OST Quality Assurance Visit • OST Quality Assurance Visit Report - Proforma • Annexures: List of common problems and their solutions; Steps for Planning and Managing QA Visits,

19. Conducting a QA visit • Inform the centre staff and concerned SACS prior to visit • During visit • Observation of the centre, including functioning of the staff and service delivery processes • Review of records • Interaction with • Staff – OST centre • Staff – linked IDU TI • Beneficiaries • Other stakeholders • Use the prescribed format to conduct the visit • Use the prescribed format to report the visit

20. Tool for OST quality assurance visit

21. Tool for OST quality assurance visit

22. Impression on Quality of OST centre • 16 - item scoring scale • Each item can be scored 1, 2 or 3 • Option for giving remarks for each item • Quality grading depends upon the total % score obtained

23. Impression on Quality of OST centre

24. Impression on Quality of OST centre

25. OST Quality Assurance visit report • Observations/findings and specific recommendations on specific areas of OST implementation • Other specific inputs provided • Issues for consideration by programme authorities

26. Annexures • List of common problems and possible solutions • Planning and managing the OST QA visits

27. Mechanisms for building capacities and ensuring quality

28. Accreditation • All NGO OST centres expected to undergo Accreditation • Accreditation for Government centres also on the anvil • Conducted by an independent agency: National Accreditation Board for Hospitals (NABH) • Through trained team of two experts (Technical + Programme) • Using a especially prepared tool • Report provides • Scores • Qualitative / descriptive information

29. Accreditation • All NGO OST centres expected to undergo Accreditation • Accreditation for Government centres also on the anvil • Conducted by an independent agency: National Accreditation Board for Hospitals (NABH) • Through trained team of two experts (Technical + Programme) • Using a especially prepared tool  • Report provides • Scores • Qualitative / descriptive information

30. The Accreditation Tool • In the form of an excel sheet • Filled by both the experts through observations and interaction

31. The Accreditation Tool • In the form of an excel sheet • Filled by both the experts through observations and interaction • Sections • Infrastructure • Staff • Service Delivery Process • Performance • Qualitative information • “Essential Items” 

32. Accreditation: Essential items

33. Resource Materials developed for Capacity Building and Quality Assurance 1. Training Manual 2. SOPs 3. Practice Guidelines 4. QA Guide

34. Thank you