Transcript www.aidsalliance.org.ua

The Essential Package
Paul Williams
United Nations Office on Drugs and Crime
Vienna
Master Class, Yalta
September 2007
From the ‘Comprehensive’ to the ‘Essential’ Package:
Core service coverage indicators
1 July 2005
“The position paper is grounded in a number of
essential principles crucial to the success of any
effective HIV prevention effort.”
3. Preventing transmission of HIV through injecting drug use
• Full range of treatment options (notably ST)
• Implementation of harm reduction measures
(through among others…
- peer outreach
- NSP)
• VCT – new - PICT
• Prevention of sexual transmission
(including condoms and STI treatment)
• Access to primary health care
• Access to ARVs
The comprehensive
package (vers. 1)
Operationalising the package at field level
• IEC
• Condoms
• ST
• NSP
• VCT
• ARVs
• STIs
• ADAS
The comprehensive
package (vers. 2)
June 2006
• UNODC convened a meeting of ~ 39 international
experts in Vienna – charged with reviewing the
Comprehensive Package, with respect to resource
poor, developing and in-transition countries
June 2006
• UNODC convened a meeting of ~ 39 international
experts in Vienna – charged with reviewing the
Comprehensive Package, with respect to resource
poor, developing and in-transition countries
• Also charged with identifying which elements of the
CP were “ Essential” and which ones were “added
value” .
Essential
Comprehensive
• IEC
•
• Condoms
•
• ST
• ST
• NSP
• NSP
• VCT
• VCT
• ARVs
• ARVs
• STIs
•
• ADAS
•
Essential
Comprehensive
Measuring the EP
• IEC
•
•
• Condoms
•
• ~Condoms~
• ST
• ST
• ST
• NSP
• NSP
• NSP
• VCT
• VCT
• VCT
• ARVs
• ARVs
• ARVs
• STIs
•
•
• ADAS
•
•
Essential
Comprehensive
Measuring the EP
• IEC
•
•
• Condoms
•
• ~Condoms~
• ST
• ST
• ST
• NSP
• NSP
• NSP
• VCT
• VCT
• VCT
• ARVs
• ARVs
• ARVs
• STIs
•
• ~STIs~
• ADAS
•
•
Essential
•
THE TWO GUIDING PRINCIPLES
•
1) While the Comprehensive
Package provides optimal results,
without at least the Essential
Package of measures, efforts will
fail
• ST
• NSP
• VCT
• ARVs
•
Essential
•
THE TWO GUIDING PRINCIPLES
•
2) Even if we do implement the
Comprehensive Package, we should
make sure we at least measure the
Essential Package
• ST
• NSP
• VCT
• ARVs
•
Impact, Coverage, Quality
Coverage
Quality
~Timing~
Impact
Impact
ONLY TWO INDICATORS MATTER
Reduction in incidence
Impact
ONLY TWO INDICATORS MATTER
Reduction in incidence
Survival (following diagnosis)
Quality
Generally, Measured at the technical level
- Standards…(e.g. WHO guidelines)
Quality
Generally, Measured at the technical level
- Standards…(e.g. WHO guidelines)
- Certification (e.g. min. of 3 years training)
Quality
Generally, Measured at the technical level
- Standards…(e.g. WHO guidelines)
- Certification (e.g. min. of 3 years training)
- Using proven effective medications etc.
Quality
Rarely is “client satisfaction”, “gender sensitivity”,
“acceptance by neighbourhood”, “level of social
disruption/crime associated with facility” etc.
measured as “QUALITY” indicators
Impact, Coverage, Quality
WHAT IF WE COULD USE COVERAGE AS A
PROXY FOR MEASURING PROGRESS IN
“PROGRAMME ROLLOUT” to prevent transmission
by injecting?
Impact, Coverage, Quality
WHAT IF WE COULD USE COVERAGE AS A
PROXY FOR MEASURING PROGRESS IN
“PROGRAMME ROLLOUT” to prevent transmission
by injecting?
And ignore for the time being, quality (which is poorly
measured in any event), and impact (which might take
years to become evident)
Impact, Coverage, Quality
WHAT IF WE COULD USE COVERAGE AS A
PROXY FOR MEASURING PROGRESS IN
“PROGRAMME ROLLOUT” to prevent transmission
by injecting?
And ignore for the time being, quality (which is poorly
measured in any event), and impact (which might take
years to become evident)
Also puts every country on equal reporting footing –
don’t need sophisticated M&E system to track
Evaluation Framework
Objective
(n=1)
Principle Outcomes
(n=3)
Key outputs
(n=12)
Activities
(n=30)
Evaluation qns
(n=60+)
Performance Indicators (n=150+)
Increase
in
specificity
So – objective was CORE INDICATORS
Challenge: 5 core indicators across each of the three service areas:
• ST (methadone, buprenorphine)
• NSP
• Diagnosis and treatment
+ three summary indicators = total of 18 core indicators
And computations should be available continuously
from routine data that are collected at service sites
First, look to existing indicators
UNGASS
Eight candidate indicators
4. Percentage of adults and children with advanced
HIV infection receiving antiretroviral therapy
4. Percentage of adults and children with advanced
HIV infection receiving antiretroviral therapy
• Not specific to IDU – (but could arrange for such a
breakdown, though not required)
4. Percentage of adults and children with advanced
HIV infection receiving antiretroviral therapy
• Not specific to IDU – (but could arrange for such a
breakdown, though not required)
• Where IDU not driving epidemic, could have high %
of non-IDU in receipt, and v.low, or no IDU
receiving = (still) high % as a result
4. Percentage of adults and children with advanced
HIV infection receiving antiretroviral therapy
• Not specific to IDU – (but could arrange for such a
breakdown, though not required)
• Where IDU not driving epidemic, could have high %
of non-IDU in receipt, and v.low, or no IDU
receiving = (still) high % as a result
• Therefore, can hide discrimination against IDU, or
ignore the potential for an IDU “breakout”
7. Percentage of women and men aged 15-49 who
received an HIV test in the last 12 months and who
know their results
7. Percentage of women and men aged 15-49 who
received an HIV test in the last 12 months and who
know their results
• Not specific to IDU (but could arrange for such a
breakdown, though not required)
7. Percentage of women and men aged 15-49 who
received an HIV test in the last 12 months and who
know their results
• Not specific to IDU (but could arrange for such a
breakdown, though not required)
• Measurement by survey (and we know how difficult
IDU are to reach) – not from actual service provision data
7. Percentage of women and men aged 15-49 who
received an HIV test in the last 12 months and who
know their results
• Not specific to IDU (but could arrange for such a
breakdown, though not required)
• Measurement by survey (and we know how difficult
IDU are to reach) – not from actual service provision data
• Computation is “Number tested and know results”/total tested
7. Percentage of women and men aged 15-49 who
received an HIV test in the last 12 months and who
know their results
• Not specific to IDU (but could arrange for such a
breakdown, though not required)
• Measurement by survey (and we know how difficult
IDU are to reach) – not from actual service provision data
• Computation is “Number tested and know results”/total tested
• So a country might have done just 10 tests of whom 9 knew
their results (=90%), and another 100,000 tests, of whom
90,000 knew their results (also = 90%); but both are ranked
equally in performance
8. Percentage of most at risk populations who received
an HIV test in the last 12 months and who know their
results
8. Percentage of most at risk populations who received
an HIV test in the last 12 months and who know their
results
• Measurement by SURVEILLANCE survey (but we know
how difficult IDU are to reach)
8. Percentage of most at risk populations who received
an HIV test in the last 12 months and who know their
results
• Measurement by SURVEILLANCE survey (but we know
how difficult IDU are to reach)
• Computation is answers to qns (a) tested? And b) got results?
8. Percentage of most at risk populations who received
an HIV test in the last 12 months and who know their
results
• Measurement by SURVEILLANCE survey (but we know
how difficult IDU are to reach)
• Computation is answers to qns (a) tested? And b) got results?
• Same result problems (3/4 returns the same result of
75,000/100,000)
8. Percentage of most at risk populations who received
an HIV test in the last 12 months and who know their
results
• Measurement by SURVEILLANCE survey (but we know
how difficult IDU are to reach)
• Computation is answers to qns (a) tested? And b) got results?
• Same result problems (3/4 returns the same result of
75,000/100,000)
• PLUS, for both this and #7 – nothing in the indicator
“requires” voluntary, confidential counselling
9. Percentage of most at risk populations with HIV
prevention programmes
9. Percentage of most at risk populations with HIV
prevention programmes
• Measurement by SURVEILLANCE survey (but we know
how difficult IDU are to reach)
9. Percentage of most at risk populations with HIV
prevention programmes
• Measurement by SURVEILLANCE survey (but we know
how difficult IDU are to reach)
• Computation is individual and sum of answers to qns (a) know where
to go for an HIV test? b) last 12 months given condoms [by IDU
service]? And c) given sterile needle and syringes [by IDU service]?
9. Percentage of most at risk populations with HIV
prevention programmes
• Measurement by SURVEILLANCE survey (but we know
how difficult IDU are to reach)
• Computation is individual and sum of answers to qns (a) know where
to go for an HIV test? b) last 12 months given condoms [by IDU
service]? And c) given sterile needle and syringes [by IDU service]?
• 1 x condom; 1 x N&S is treated equally as 100 condoms and
say, 300 needles and syringes
14. Percentage of most at risk populations who both
correctly identify ways of preventing the sexual
transmission of HIV and who reject major
misconceptions about HIV transmission
14. Percentage of most at risk populations who both
correctly identify ways of preventing the sexual
transmission of HIV and who reject major
misconceptions about HIV transmission
• Proxy for IEC coverage, but not specific to transmission by the
injection route – important, but outside the scope of our intention
14. Percentage of most at risk populations who both
correctly identify ways of preventing the sexual
transmission of HIV and who reject major
misconceptions about HIV transmission
• Proxy for IEC coverage, but not specific to transmission by the
injection route – important, but outside the scope of our intention
• PLUS – measures knowledge, not actual behavior change
20. Percentage of injecting drug users reporting the
use of a condom the last time they had sexual
intercourse
20. Percentage of injecting drug users reporting the
use of a condom the last time they had sexual
intercourse
• Proxy for IEC coverage, but not specific to transmission by
the injection route – important, but outside the scope of our
intention – nonetheless, we think about this one
20. Percentage of injecting drug users reporting the
use of a condom the last time they had sexual
intercourse
• Proxy for IEC coverage, but not specific to transmission by
the injection route – important, but outside the scope of our
intention – nonetheless, we think about this one
• Measures actual behavior change, so good – another reason
to think about it
20. Percentage of injecting drug users reporting the
use of a condom the last time they had sexual
intercourse
• Proxy for IEC coverage, but not specific to transmission by
the injection route – important, but outside the scope of our
intention – nonetheless, we think about this one
• Measures actual behavior change, so good – another reason
to think about it
• But, only applies to countries where injecting is an
established mode – why not all countries?
21. Percentage of injecting drug users reporting the
use of sterile injecting equipment the last time they
injected
21. Percentage of injecting drug users reporting the
use of sterile injecting equipment the last time they
injected
• Surveillance survey (and we know how difficult IDU are to
reach)
21. Percentage of injecting drug users reporting the
use of sterile injecting equipment the last time they
injected
• Surveillance survey (and we know how difficult IDU are to
reach)
• Proxy for actual coverage by NSP (in addition to
knowledge), so why not measure actual coverage
23. Percentage of most at risk populations who are
HIV infected
23. Percentage of most at risk populations who are
HIV infected
• Very important, not a coverage indicator per se, but will be
necessary as a denominator for say, ARV coverage
So, UNGASS summary
• Only two are actual coverage indicators (8 & 9) – but
measurement/interpretation problems
So, UNGASS summary
• Only two are actual coverage indicators (8 & 9) – but
measurement/interpretation problems
• 1 useful for coverage denominator purposes (23), but it is
really an impact indicator (which itself is very good)
What about the Current Ukraine M&E plan
• Uses 7 core indicators from UNGASS, plus 2
“additionals”, including 1 replacement of one UNGASS core
indicator”
Additional # 1
VCT1 -Population requesting an HIV test, receiving a
test and receiving test results
Additional # 1
VCT1 -Population requesting an HIV test, receiving a
test and receiving test results
• This is the replacement for UNGASS, not specific to
IDU, (but could arrange for such a breakdown, though not required)
Additional # 1
VCT1 -Population requesting an HIV test, receiving a
test and receiving test results
• This is the replacement for UNGASS, not specific to
IDU, (but could arrange for such a breakdown, though not required)
• Suffers from the same computational/interpretational
problems previously identified
Additional # 2
VUL2 –Percentage of respondents in a survey of
injecting drug users who, in response to prompting,
identify switching to non-injectable drugs, avoiding
sharing injecting equipment, and cleaning injecting
equipment with bleach as methods of preventing HIV
transmission
Additional # 2
VUL2 –Percentage of respondents in a survey of
injecting drug users who, in response to prompting,
identify switching to non-injectable drugs, avoiding
sharing injecting equipment, and cleaning injecting
equipment with bleach as methods of preventing HIV
transmission
• (phew – quite a mouthful)
Additional # 2
VUL2 –Percentage of respondents in a survey of
injecting drug users who, in response to prompting,
identify switching to non-injectable drugs, avoiding
sharing injecting equipment, and cleaning injecting
equipment with bleach as methods of preventing HIV
transmission
Survey – community of IDU – good, but how many?
representativeness etc.
Additional # 2
VUL2 –Percentage of respondents in a survey of
injecting drug users who, in response to prompting,
identify switching to non-injectable drugs, avoiding
sharing injecting equipment, and cleaning injecting
equipment with bleach as methods of preventing HIV
transmission
Prompting??? hmmm.
Additional # 2
VUL2 –Percentage of respondents in a survey of
injecting drug users who, in response to prompting,
identify switching to non-injectable drugs, avoiding
sharing injecting equipment, and cleaning injecting
equipment with bleach as methods of preventing HIV
transmission
Calculation = all three must be answered correctly,
but bleach is a problem
Bleach
• Qn comes from UNAIDS 2000 publication
Bleach
• Qn comes from UNAIDS 2000 publication
• WHO and UNODC (soon UNAIDS) no longer
recommend bleach
Bleach
• Qn comes from UNAIDS 2000 publication
• WHO and UNODC (soon UNAIDS) no longer
recommend bleach
• So, someone who is up to date on the withdrawal of
recommendation will not identify/report using
bleach, just as someone who is not aware, but didn’t
use it anyway
Bleach
• Qn comes from UNAIDS 2000 publication
• WHO and UNODC (soon UNAIDS) no longer
recommend bleach
• So, someone who is up to date on the withdrawal of
recommendation will not identify/report using
bleach, just as someone who is not aware, but didn’t
use it anyway
• So indicator no longer accurate, and a proxy anyway,
for actual coverage
Bleach
• Qn comes from UNAIDS 2000 publication
• WHO and UNODC (soon UNAIDS) no longer
recommend bleach
• So, someone who is up to date on the withdrawal of
recommendation will not identify/report using use
bleach, just as someone who is not aware, but didn’t
use it anyway
• So indicator no longer accurate, and a proxy anyway,
for actual coverage
Ukraine SUMMARY
Doesn’t add to what we got from UNGASS
CORE INDICATORS
Challenge: 5 core indicators across each of the three service areas:
• ST (methadone, buprenorphine)
• NSP
• Diagnosis and treatment
+ three summary indicators = total of 18 core indicators
And computations should be available continuously
from routine data that are collected at service sites
Essential
Comprehensive
Measuring the EP
• IEC
•
•
• Condoms
•
• ~Condoms~
• ST
• ST
• ST
• NSP
• NSP
• NSP
• VCT
• VCT
• VCT
• ARVs
• ARVs
• ARVs
• STIs
•
• ~STIs~
• ADAS
•
•
Summary measures
A) Elements (and year of introduction) of the essential package
provided to IDU
B) Number and proportion of IDU service sites providing each element
of the essential package
C) Number and proportion of IDU covered by each element of the
Essential package
Summary measures
A) Elements (and year of introduction) of the essential
package provided to IDU
First step – provide? y/n
ST
NSP
VCT
ARVs
All

x


x
Summary measures
A) Elements (and year of introduction) of the essential
package provided to IDU
Second step – Year of introduction
ST
NSP
VCT
ARVs
All
1998
-
2001
2003
-
Summary measures
B) Number and proportion of IDU service sites
providing each element of the essential package
Begs the question – what is a “service site”?
And that is where the data dictionary comes in – it
provides a guide – distinguishes between “fixed” and
“mobile” sites
Summary measures
B) Number and proportion IDU service sites providing
each element of the essential package
“proportion” requires knowing how many sites in
total (as the denominator)
And this means public, private, ngos etc. So we need
to know the sites.
Summary measures
B) Number and proportion IDU service sites providing
each element of the essential package
1
NSP
ST
VCT
ARVs
Kazakhstan
129 (NAC)
0 (0%)
659 (NAC)
22 (NAC)
0 (0%)
Kyrgyzstan
51 (NAC)
2 (NAC)
14 (NAC)
6 (NAC)
0 (0%)
Tajikistan
26 (NAC)
n/a
140 (NAC)
7 (NAC)
0 (0%)
NEA (NAC)
n/a
NEA (NAC)
NEA (NAC)
0 (0%)
235 (99%)
1 (0.4%)
233 (98%)
2 (0.8%)
0 (0%)
Turkmenistan
Uzbekistan
NEA – No estimate available ; NAC – No estimate able to be computed (e.g. denominator missing)
All elements
Summary measures
B) Number and proportion IDU service sites providing
each element of the essential package
1
NSP
ST
VCT
ARVs
Kazakhstan
129 (NAC)
0 (0%)
659 (NAC)
22 (NAC)
0 (0%)
Kyrgyzstan
51 (NAC)
2 (NAC)
14 (NAC)
6 (NAC)
0 (0%)
Tajikistan
26 (NAC)
n/a
140 (NAC)
7 (NAC)
0 (0%)
NEA (NAC)
n/a
NEA (NAC)
NEA (NAC)
0 (0%)
235 (99%)
1 (0.4%)
233 (98%)
2 (0.8%)
0 (0%)
Turkmenistan
Uzbekistan
NEA – No estimate available ; NAC – No estimate able to be computed (e.g. denominator missing)
All elements
Summary measures
B) Number and proportion IDU service sites providing
each element of the essential package
1
NSP
ST
VCT
ARVs
Kazakhstan
129 (NAC)
0 (0%)
659 (NAC)
22 (NAC)
0 (0%)
Kyrgyzstan
51 (NAC)
2 (NAC)
14 (NAC)
6 (NAC)
0 (0%)
Tajikistan
26 (NAC)
n/a
140 (NAC)
7 (NAC)
0 (0%)
NEA (NAC)
n/a
NEA (NAC)
NEA (NAC)
0 (0%)
235 (99%)
1 (0.4%)
233 (98%)
2 (0.8%)
0 (0%)
Turkmenistan
Uzbekistan
NEA – No estimate available ; NAC – No estimate able to be computed (e.g. denominator missing)
There are a total of 238 sites.
All elements
Summary measures
B) Number and proportion IDU service sites providing
each element of the essential package
Uzbekistan
NSP
ST
VCT
ARVs
All elements1
235 (99%)
1 (0.4%)
233 (98%)
2 (0.8%)
0 (0%)
From the 238 sites, 99% (n=235) provide NSP
Summary measures
B) Number and proportion IDU service sites providing
each element of the essential package
Uzbekistan
NSP
ST
VCT
ARVs
All elements1
235 (99%)
1 (0.4%)
233 (98%)
2 (0.8%)
0 (0%)
From the 238 sites, 98% (n=233) provide VCT
Summary measures
B) Number and proportion IDU service sites providing
each element of the essential package
Uzbekistan
NSP
ST
VCT
ARVs
All elements1
235 (99%)
1 (0.4%)
233 (98%)
2 (0.8%)
0 (0%)
From the 238 sites, 0.4% (n=1) provides ST
Summary measures
B) Number and proportion IDU service sites providing
each element of the essential package
Uzbekistan
NSP
ST
VCT
ARVs
All elements1
235 (99%)
1 (0.4%)
233 (98%)
2 (0.8%)
0 (0%)
From the 238 sites, 0.8% (n=2) sites provide ARVs.
Summary measures
B) Number and proportion IDU service sites providing
each element of the essential package
Uzbekistan
NSP
ST
VCT
ARVs
All elements1
235 (99%)
1 (0.4%)
233 (98%)
2 (0.8%)
0 (0%)
From the 238 sites, no sites provide all elements – nor
should they (re. ARVs)
Summary measures
B) Number and proportion IDU service sites providing
each element of the essential package
Uzbekistan
NSP
ST
VCT
ARVs
All elements1
235 (99%)
1 (0.4%)
233 (98%)
2 (0.8%)
0 (0%)
But it does raise the qn – what is the right mix?
The right mix?
Uzbekistan
NSP
ST
VCT
ARVs
All elements1
235 (99%)
1 (0.4%)
233 (98%)
2 (0.8%)
0 (0%)
Only two sites offering ARVs – not enough
Only one site offering ST – definitely not enough
Virtually all “Trust Points” offer NSP and VCT – v.good. But
are 235 Trust Points enough for 300,000 IDU? Are they in the
right places? Simply by mapping the sites and collecting these
data raises more, and appropriate qns!
C) Number and proportion of IDU covered by each
element of the Essential package
• Basic information – yes?
NSP
ST
VCT
ARVs
All elements
Kazakhstan
NEA (NAC)
O (0%)
22 248 (NAC)
205 (0.2%)
NEA (NAC)
Kyrgyzstan
NEA (NAC)
227 (0.9%)
NEA (NAC)
NEA (NAC)
NEA (NAC)
Tajikistan
NEA (NAC)
0 (0%)
4 991 (33%)
NEA (NAC)
NEA (NAC)
Turkmenistan
NEA (NAC)
0 (0%)
NEA (NAC)
NEA (NAC)
NEA (NAC)
Uzbekistan
NEA (NAC)
152 (0.2%)
10 994 (14%)
482 (0.6%)
NEA (NAC)
Azerbaijan
2 724 (0.9%)
90 (<0.1%)
3 568 (1%)
11 (NAC)
NEA (NAC)
C) Number and proportion of IDU covered by each
element of the Essential package
• Basic information – yes?
NSP
ST
VCT
Kazakhstan
O (0%)
Kyrgyzstan
227 (0.9%)
ARVs
22 248 (NAC)
205 (0.2%)
Tajikistan
0 (0%)
4 991 (33%)
Turkmenistan
0 (0%)
)
152 (0.2%)
10 994 (14%)
482 (0.6%)
90 (<0.1%)
3 568 (1%)
11 (NAC)
Uzbekistan
Azerbaijan
2 724 (0.9%)
All elements
C) Number and proportion of IDU covered by each
element of the Essential package
• Basic information – yes?
NSP
ST
VCT
Kazakhstan
O (0%)
Kyrgyzstan
227 (0.9%)
Tajikistan
0 (0%)
Turkmenistan
0 (0%)
Uzbekistan
Azerbaijan
2 724 (0.9%)
ARVs
205 (0.2%)
4 991 (33%)
152 (0.2%)
10 994 (14%)
90 (<0.1%)
3 568 (1%)
482 (0.6%)
All elements
SKIP AHEAD to other basic indicators
• Result is even worse
Number (and
Number (and
proportion) of IDU
proportion) of
who received STI functional sites with
testing and treatment
IEC provision on
in the past year.
[census date]
Number (and
proportion) of IDUs
who received IEC
materials, at least
once, in the last
three months
Kazakhstan
NEA (NAC)
NEA (NAC)
NEA (NAC)
Kyrgyzstan
NEA (NAC)
NEA (NAC)
NEA (NAC)
Tajikistan
NEA (NAC)
NEA (NAC)
NEA (NAC)
Turkmenistan
NEA (NAC)
NEA (NAC)
NEA (NAC)
Uzbekistan
NEA (NAC)
NEA (NAC)
NEA (NAC)
Azerbaijan
NEA (NAC)
NEA (NAC)
NEA (NAC)
A quick cautionary note - KISS
A quick cautionary note - KISS
So, even basic information is lacking, not collected, or
not regionally/nationally collated/aggregated.
A quick cautionary note - KISS
So, even basic information is lacking, not collected, or
not regionally, nationally collated/aggregated.
What will it be like for sophisticated, multi-layered
indicators requiring multiple sources, various surveys
(e.g.2nd gen)
NSP
1. Number and proportion of IDU in (at least) weekly contact with NSP
2. Average number of needles and syringes provided per weekly client
per contact
3. Total number of needles and syringes distributed in past year
4. Average number of condoms provided per (any) client per contact
5. Total number of condoms distributed to IDU in past year
NSP
1. Number and proportion of IDU in (at least) weekly contact with NSP
Begs the qn – how many IDU are there?
Triangulated convergent validity study
Primary research (e.g. surveys)
Result
KI interviews
Desk review – official,
surveillance data
NSP
1. Number and proportion of IDU in (at least) weekly contact with NSP
Why at least weekly?
• We wanted to distinguish between “once only” and
“occasional” from “regular” – it was regular that we wanted to
measure
NSP
1. Number and proportion of IDU in (at least) weekly contact with NSP
Why at least weekly?
• What does “regular” mean? Why not just impose
“weekly” as a proxy (note: WHO uses “monthly”)
NSP
1. Number and proportion of IDU in (at least) weekly contact with NSP
How do we measure “weekly”
Firstly – need to record frequency of IDU contacts
Secondly– need to know uniqueness of contact (are
IDU securing N&S from multiple NSPs).
Therefore – need for a unique identifier
NSP
Unique identifier
• First two letters of mother’s first name
• First two letters of father’s first name
• Gender (single letter M/F or number)
• Year of birth (last two digits).
NSP
Unique identifier
Paul Williams
• First two letters of mother’s first name = JU
• First two letters of father’s first name = KE
• Gender (single letter M/F or number) = M
• Year of birth (last two digits) = 54
Unique identifier = JUKEM54
NSP
Unique identifier
Not totally duplicate proof
• First two letters of mother’s first name = June vs Judy
• First two letters of father’s first name = Ken vs Keely
• Gender (single letter M/F or number) = both M
• Year of birth (last two digits) = both born 1954
Therefore “Unique” identifier = JUKEM54 for more
than one individual
NSP
Unique identifier
Not useful in all circumstances
IDU who do not know one or more parents
IDU who do not know year of birth
NSP
2. Average number of needles and syringes provided per weekly client
per contact
2. Average number of needles and syringes provided
per weekly client per contact
• Is the optimum number of needles and syringes
being distributed?
2. Average number of needles and syringes provided
per weekly client per contact
• Is an “adequate” number being distributed
2. Average number of needles and syringes provided
per weekly client per contact
What does WHO say is an “adequate” number?
NSP
3. Total number of needles and syringes distributed in past year
3. Total number of needles and syringes distributed in
past year
• We can compare the average number with total
number
3. Total number of needles and syringes distributed in
past year
• We can then work out ~regular “take” of total
3. Total number of needles and syringes distributed in
past year
• We can then work out ~regular “take” of total
• If matches- v.good; if does not, this indicates
problems with the service or measurement etc.
NSP
4. Average number of condoms provided per (any) client per contact
5. Total number of condoms distributed to IDU in past year
4. Average number of condoms provided per (any)
client per contact
5. Total number of condoms distributed to IDU in
past year
• This was an attempt to compare IDU to non-IDU,
however, in retrospect we should have compared
average (to non-IDU) with average (to IDU)
4. Average number of condoms provided per (any)
client per contact
5. Total number of condoms distributed to IDU in
past year
5. Average number of condoms distributed to IDU in
past year
Substitution treatment
1. Number and proportion of opioid IDU receiving daily dosing of
a) methadone and b) buprenorphine for at least 6 months in the past
year
2. Average dose of a) methadone and b) buprenorphine
3. Number and proportion of prison opioid IDU receiving a) methadone
and b) buprenorphine on [census date]
4. Average dose of a) methadone and b) buprenorphine provided to
prison opioid IDU
5. Number and proportion of opioid IDU enrolled in any form of nondetox drug treatment for at least 30 days in the past year
Diagnosis and treatment
1. Number and proportion of IDU who received VCT in the past year
2. Number and proportion of all persons who received VCT in past year
who are IDU
3. Number and proportion of HIV+ IDU who are receiving ARV on
[census date]
4. HIV+ persons in receipt of ARVs who are IDU on [census date] as a
proportion of all in receipt of ARVs
5. Number and proportion of IDU who received STI testing and
treatment in the past year
The way forward
Advocate for (at least) the Essential Package
Implement (at least) the Essential Package
Measure (at least) the Essential Package
Then pick up on any of the other measures of the
Comprehensive Package
Questions?