Transcript Meeting need - Andrew Preston

Meeting need
and improving coverage
workshop
Meeting need:
calculating
and improving coverage
What is coverage?
Coverage is a measure of the ‘reach’ of a healthcare
intervention to a population
Definitions have included:
• the range of services on offer to a geographical
area
• % of injectors ever in contact with services
• % of injectors reached in a specific period
• number of syringes per injector per year
What is coverage?
The coverage definition most appropriate for the UK is:
the percentage of injections
for which a new sterile syringe
has been distributed by services.
why does coverage matter?
Coverage matters because:
• we know that injectors will use a new needle and
syringe if they have one
• evidence from Bristol showed that high coverage
was associated with reduced risk of hcv infection
• it measures the impact of service provision on
both those in contact, and those not in contact
with services
The coverage calculator…
As part of the Harm Reduction Works campaign we
began to develop an online calculator to work out
coverage.
It’s in a peer review process, so there will be some
changes, mainly to bring it more fully into line with the
NICE guidance
The calculator
what does the calculator say?
1% – 9%: coverage is very low
“If the figures you put in are right - there is a serious
shortage of sterile injecting equipment in your area…”
“In these conditions blood borne viruses can spread
rapidly amongst injecting drug users. This coverage may
be too low to prevent an HIV outbreak, and will not
reduce hepatitis C (HCV) transmission. If it persists, HCV
infection will rise above 50% of the injecting population,
if it is not there already.”
1% – 9%: advice includes
ensure everyone in contact with services knows how to
clean syringes with bleach so that in situations where
they are reusing or sharing equipment, they can reduce
the risk.
10% to 19%: coverage is low
“In low HIV prevalence areas (under 2%) coverage even
at this level is probably high enough to prevent a
widespread epidemic of HIV (but, localised epidemics are
possible, and an epidemic could happen quickly if the
number of infected individuals rises).”
“in low hepatitis C prevalence areas - under 25% coverage at this level, in conjunction with good quality
opioid substitution treatment (OST), may appear to have
held prevalence at its current level, however the
situation could change rapidly…”
10% to 19%: urgent action points
Urgent action points
• Conduct an audit of commissioning and Needle and
Syringe Programme (NSP) delivery to identify areas of
non-compliance with the NICE public health guidance…
• Talk to injecting drug users and service providers to
identify areas of low coverage and/or poor access to
services and also access to syringes, sharing, and syringe
reuse…
• Increase the number of opiate injecting drug users who
have access to good quality opioid substitute
prescribing;
20% – 32%:
coverage needs improving
If the figures you have put in - particularly the estimate
for the number of injecting drug users - are right,
coverage will probably prevent an HIV epidemic in low
prevalence countries such as the UK.
…Although it will reduce the numbers of injecting drug
users catching hepatitis C, it is unlikely to make
significant inroads into reducing the incidence and
prevalence of hepatitis C.
20% – 32% – advice includes
access to syringes is unlikely to be even…
Those reliant on secondary exchange are likely to be using
each syringe far more times than the average, and be more
likely to share.
Ensure that limits are not being placed on the amount of
equipment injecting drug users can take
33% to 69%: coverage should be
further improved
coverage is likely to prevent an HIV epidemic while
prevalence of HIV remains low.
…It is also likely that there will be significant reduction in
the transmission of hepatitis C.
Sharing of syringes is still likely to be occurring,
particularly in groups with reduced access to the
injecting equipment that is being distributed.
33% to 69%: advice includes
Encourage those injecting drug users in contact with
services to take all the equipment they need so that they
have at least one syringe for every injection, and are able
to take additional equipment to distribute to their peers.
70% to 99%
coverage to a substantial proportion of
injectors is good, but further improvement is
needed for service provision to be NICE
guidance compliant
70% to 99% – advice includes
Check the figures for the number of injecting drug users,
the number in treatment, and number of syringes
distributed are accurate, and if they are continue to:
•Identify high risk groups and improve access to services
for them;
•Monitor the number of needles and syringes
distributed;
100%+: coverage is excellent
It is still important for services to:
• take steps to enable people to get into opioid
substitution therapy so they can reduce or stop their
injecting, and reduce the risk of accidental BBV infection
and overdose
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