Transcript and injection drug users (IDUs) in Central Asia

Use of DatStat software for data collection, monitoring and evaluation of
naloxone peer distribution programs to respond to opiate overdoses among
people living with HIV (PLWH) and injection drug users (IDUs) in Central Asia
Sholpan Primbetova, Nabila El-Bassel, Louisa Gilbert, Assel Terlikbayeva, Tim Hunt, Anne Malin
Columbia University
Global Health Research Center of Central Asia
Almaty, Kazakhstan
Table 1. Outcomes of overdose reversal and fatality in CA
Introduction
Death from opiate overdose is one of the leading causes of mortality among
PLWH and IDUs in Central Asia. However, none of these countries have official
data on opiate overdose cases or monitor the use of naloxone. Project ADVANCE
(Advocacy and Assessment of Naloxone in Central Asia) is designed to develop
tools for evidence-based advocacy and to strengthen capacity of local NGOs
through educating them to use
an electronic information system
to track the response to HIV
and overdose.
Map of Central Asia identifying the project’s geography:
Almaty in Kazakhstan, Bishkek and Osh in Kyrgyzstan,
Dushanbe and Khorog in Tajikistan
Outcome of Overdose Incident
when Naloxone was
Administered
Kazakhstan Kyrgyzstan
Tajikistan
Count
Pct
Count
Pct
Count
Pct
49
87,5%
21
95,5%
28
26,7%
6
10,7%
0
0%
74
70,5%
0
0%
0
0%
2
1,9%
The person died immediately
1
1,8%
1
4,5%
1
0,9%
The person died in the hospital
0
0%
0
0%
0
0%
Successful reversal:
The person recovered without
medical aid
The person recovered after
rendering him/her medical aid
The person was taken to the
hospital
Fatal incidence:
Materials and Methods
Regional Capacity Building
 Established local partnerships with 6 sites in
three countries
 Conducted needs assessment on overdose
and naloxone use by ambulances and NGOs
 Conducted training for partners on naloxone
peer distribution and client outreach
 Developed and implemented a system for electronic data collection,
monitoring and evaluation of overdose incidents, and use of naloxone for
partners using DatStat
 Trained partners to collect data using
hand held devices which connect to
a secure server and allow for remote
data collection
u
Conclusion and Recommendations
 The findings suggest region-wide peer distribution of naloxone is safe and
effective and should be scaled up
 Several barriers impeded naloxone distribution in different countries that need to
be addressed in the future, including fear of arrest for carrying naloxone, need to
register as a drug user to receive naloxone and interruptions in naloxone supply
 Conducted stakeholders regional
conference to discuss findings from
pilot naloxone distribution project, identify barriers to distribution, and make
policy and program recommendations
 Cross-cutting country-wide and regional partnerships with government and NGO
partners are essential for addressing barriers to scaling up naloxone distribution
 Surveillance of overdose morbidity and mortality in all three countries is woefully
inadequate. Electronic data management system on overdose employed by this
project holds promise as a tool to improve surveillance
 Data on overdose incidence and use of naloxone are needed to advocate for
policies and programs that will widen access to naloxone among PLWHA and
PWID
Results
Final 2011 data collected from 212 IDUs and 5 NGOs:
Literature Cited
Атаянц, Ж., Латыпов, А., Очерет, Д., (2011). Передозировка: Обзор ситуации и ответные меры в 12 странах
Восточной Европы и Центральной Азии. Вильнюс: Евразийская сеть снижения вреда.
Bartlett, N., Xin, D., Zhang, H., and Huang, B. (2011). A qualitative evaluation of a peer-implemented overdose
response pilot project in Gejiu, China. The International journal on drug policy, 22(4), 301-305.
Bennett, A. S., Bell, A., Tomedi, L., Hulsey, E. G., and Kral, A. H. (2011). Characteristics of an Overdose Prevention,
Response, and Naloxone Distribution Program in Pittsburgh and Allegheny County, Pennsylvania. Journal of urban
health bulletin of the New York Academy of Medicine. Retrieved from ttp://www.ncbi.nlm.nih.gov/pubmed/21773877
Coffin, P., Overdose: A Major Cause of Preventable Death in Central and Eastern Europe in Central Asia
Recommendations and overview of the situation in Latvia, Kyrgyzstan, Romania, Russia and Tajikistan, Eurasian
Harm Reduction Network (EHRN), Vilnius, August 2008.
El-Bassel, N., et al. (2012). Overdose Prevention among IDUs in Kazakhstan: The Role of Naloxone in Opioid Overdose
Fatality Prevention. Paper presented at the Federal Drug Administration Hearing: Role of Naloxone in Opioid Fatality
Prevention, Silver Spring, Maryland;
Gaston, R. L., Best, D., Manning, V., and Day, E. (2009). Can we prevent drug related deaths by training opioid users
to recognize and manage overdoses? Harm Reduction Journal, 6(1), 26. BioMed Central.
North Carolina Medical Board (2007). Project Lazarus: Policy Briefing Document. Wilkes County, North Carolina.
Primbetova, S., et al. (2012). Making Naloxone available for those who need it: from needs assessment to advocacy.
Unpublished. Columbia University Global Health Research Center of Central Asia, Almaty, Kazakhstan.
Seal, K. H., Thawley, R., Gee, L., Bamberger, J., Kral, A. H., Ciccarone, D., Downing, M., et al. (2005). Naloxone
distribution and cardiopulmonary resuscitation training for injection drug users to prevent heroin overdose death: a
pilot intervention study. Journal of urban health bulletin of the New York Academy of Medicine, 82(2), 303-311.
Tobin, K. E., Sherman, S. G., Beilenson, P., Welsh, C., & Latkin, C. A. (2009). Evaluation of the Staying Alive programme: training injection drug users to properly administer naloxone and save lives. The International journal on drug
policy, 20(2), 131-136. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/18434126
 188 (94.7%) cases of naloxone
administration were analyzed and
demonstrated effectiveness in reversing
overdose experienced by IDUs
 24 (13%) did not use naloxone after
receiving it (1 case in Tajikistan, 7 cases
in Kazakhstan, and 16 cases in
Kyrgyzstan)
 98 (52%) recovered without additional
medical aid
 80 cases (42.6%) recovered after
ambulance was called
 2 cases (1.1%) were taken to the
hospital by ambulance and survived
 5 cases of missing data
Acknowledgments
 3 cases (1.6%) in
which people died
due to late injection
of naloxone or a
heavy mix of alcohol
We thank Open Society Foundations for providing funding opportunities for the ADVANCE
study in Kazakhstan, Kyrgyzstan and Tajikistan. We thank NIDA for providing funding for the
Renaissance study where peer distribution of naloxone was introduced in Kazakhstan. We
highly appreciate the collaboration on this project with NGOs “Volontyor,” “Apeyron,” and
Open Society Foundations Assistance Foundation (Tajikistan), NGOs “Attika” and “Parents
Against Drugs” and Soros Foundation (Kyrgyzstan) and Renaissance team, NGO
“Doverie” and Almaty emergency station (Kazakhstan).
Presented at AIDS 2012 – Washington, D.C., USA