Transcript Data analysis

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
 Numbers of female PWID – not known
 Estimated number of HIV infected PWID - 444
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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
8
7
7
7
6
4.9
5.3
5
%
4
4
4
3
2
1.7
2
1.8
1.4
0.8
1
0
0
0
1999-2000
2000-2001
2002
2003-2004
PWID-Dhaka
PWID-Chandpur
PWID-Ishwardi
Heroin smokers-Dhaka
Combined female-Dhaka, N.ganj and Tongi
1.1 1
0.6
0.8
0.5
0 0
2004-2005
0
0
2006
1.7
1 0.9
0.8
0.30.6
0.2
0
2007
PWID-Narayanganj
PWID-Teknaf
PWID-Satkhira
Combined male-Khulna
Combined female-Benapole
1.5
1.2
1
0.4
0
2011
SYPHILLIS PREVALENCE AMONG PWUD, 2011
(source: 9th round HIV serological surveillance, NASP)
0
0
0
0
0
0
Combined PWID/HS female-Benapole (N=98)
PWID male-Benapole (N=96)
Combined PWID/HS male-Patuakhali (N=105)
Combined PWID/HS male-Bagerhat N=134)
PWID male-Sathkhira (N=285)
PWID male-Pabna (N=101)
PWID male-Dinajpur (N=385)
PWID male-Barisal (N=404)
Combined PWID/HS male-Khulna (N=400)
PWID male-Naogaon (N=382)
PWID male-Char Norendrapur (N=124)
Combined PWID/HS male-Jaipurhat (98)
Combined PWID/HS male-Mongla (N=93)
PWID male-Kanshat (N=92)
Combined PWID/HS male-Jhenaidah (N=80)
Combined PWID/HS male-Kushtia (N=136)
PWID male-Sirajganj (N=344)
PWID male-Chapai Nawabganj (N=220)
PWID male-Mymensingh (N=375)
PWID male-HILI (N=138)
PWID male-Rajshahi (N=401)
PWID male-Srimongol (N=79)
PWID male-Jessore (N=190)
PWID male-Rangpur (N=103)
Heroin smoker male-Dhaka (N=388)
PWID male-Tongi (149)
PWID male-Dhaka (N=1243)
PWID male-Teknaf (N=96)
PWID male-Ishwardi (N=57)
PWID male-Narayanganj (N=261)
Combined PWID/HS female-Dhaka, N ganj, Tongi (N=256)
PWID male-Chandpur (N=115)
PWID male-Norsingdi (N=101)
0.5
0.7
0.8
0.8
0.8
1.0
1.1
1.1
1.3
1.5
1.7
1.8
2.1
2.2
2.5
2.5
2.6
2.9
3.4
3.4
4.3
5.2
5.3
5.4
5.9
6.1
7.9
0
1
2
3
4
5
6
7
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
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HARM REDUCTION SERVICES AVAILABLE IN
BANGLADESH, 2012
PRESENT
NUMBER OF SITES
NUMBER OF BENEFICIARIES
NSP
70 (supported by the Global Fund through Save
the Children)
14,000 PWID Including
400-500 female PWUD
OST
1 (supported by UNODC and fhi360,
implemented by icddr,b)
163 PWID including 8 females
1 (supported by Global Fund through Save the
Children, will be implemented by CARE,
Bangladesh with technical support from icddr,b
and UNODC ROSA)
150 (planned)
FUTURE (additional)
SOURCE OF FUNDING
NUMBER OF BENEFICIARIES
NSP
NASP
6,000 PWID
OST
NASP
150 PWID
GLOBAL FUND
150 PWID
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Phase II of Project RAS/H13 in
Bangladesh: an Overview
Focal Agencies: DNC and NASP
1. 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
2. Opioid Substitution Therapy (OST)
Implementer and technical agency: icddr,b
Duration: March 2010 - ongoing.
INTERVENTION AREAS OF PNGOs
IN BANGLADESH
INTERVENTION AREA
FOR OST
Central Drug Addiction Treatment Centre (CTC)
under the DNC in Dhaka
CAPACITY BUILDING OF PNGOs
 Training – 15 events
a)
b)
c)
d)
e)
f)
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
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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)
NUMBERS OF BENEFICIARIES
Note: in 2009, 83 male PWUD also covered (optional) in Gazipur
in 2011, services were provided up to October 2011
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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
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RSRAs
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
90
80
70
60
% 50
40
30
20
10
0
Baseline (N=137)
Midline (N=214)
Baseline(N=176)
Midline(N=306)
20**
78**
71
67
83**
43
26
12
56**
7*
Injected any
Ever sold sex in
drugs in the last
exchange of
six months
drugs/money
Opted for HIV
testing
Perceived
discrimination
from health
provider
Opted for STI Rx
in the last six
month
* p<0.05, **p<0.01
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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
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Opioid Substitution Therapy (OST)
Pilot in Dhaka, Bangladesh
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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
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OST USING METHADONE
 Establishment of one MMT centre at CTC
 Opened on 8 July 2010
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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
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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% )
9
8
Number of cases
6
3
1
Not willing to
continue
methadone
Jail
Moved to Village
Deceased
Religious work
(Chillah)
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METHADONE DOSAGE
“START LOW AND GO SLOW”
•
Initial phase:
o Lowest dose - 10 mg
o Highest dose - 30 mg
o Average dose - 15 mg
•
Maintenance phase:
o Lowest dose - 20 mg
o Highest dose – 165 mg
o Average dose - 50 mg
•
Discontinuation phase: 12 PWID
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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
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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
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DEMOGRAPHIC PROFILE AT BASELINE (N=129)
% (n)
Frequency of age
18 – 24 years
25 – 34 years
35 – 44 years
45 year & more
1.6 (2)
37.2 (48)
45.0 (58)
16.3 (21)
Sex
Male
Female
96.9 (125)
3.1 (4)
Marital status
Unmarried
Currently married
Separated/divorced/widow/widower
24.8 (32)
52.7 (68)
22.5 (29)
Education
Never been to school/can sign
Class I – V
Class VI – SSC
HSC/Graduate
24.0 (31)
36.1 (47)
32.6 (42)
7.0 (9)
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MAJOR SOURCES OF INCOME (N=129)
Main sources of income in the last
three months (Multiple Responses)
Baseline 1st quarter 2nd quarter
% (n)
% (n)
% (n)
Rickshaw puller/Driver/Transport worker 30.2 (39)
22.5 (29)
20.9 (27)
Small trade (tea stall, fruit seller etc.)
21.7 (28)
16.3 (21)
15.5 (20)
Service (paid job)
24.8 (32)
25.6 (33)
32.6 (40)
Tokai/garbage collector/daily
labour/beggar/cleaner
51.9 (67)
6.2 (8)
9.3 (12) *
Drug selling/cheating/stealing/
snatching/ extortion†
40.3 (52)
0
0
Family member/family property
56.6 (73)
38.8 (50)
27.1 (35)*
NB: † p value is not calculated
* p<0.001
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LIVING STATUS AND MARITAL SATISFACTION
Baseline (N=129)
1st Quarter (N=129)
2nd Quarter (N=129)
100
80
%
61
60
91 90**
66*
58
47
35
40
20
Baseline (N=67)
1st Quarter (N=69)
2nd Quarter (N=79)
18
16
23 24*
10
0
Marital satisfaction
(among those who are married)
Current living status
* p<0.01; **p<00.05
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EXPERIENCED DEPRESSION (N=129)
100
89
Baseline
1st Quarter
2nd Quarter
95*
80
% 60
40
52
47
27 30*
25
16
20
9
5
0
Depression
in the last
three months
Normal
Mild
4
6
11
1*
Moderate
1
0
Severe
0
0
Ext. Severe
Level of depression on DASS-21҂ scale in the last month
NB: ҂ Depression Anxiety and Stress Scale (DASS-21)
*p<0.01; **p<0.001
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QUALITY OF LIFE ON WHOQOL BREF SCALE (N=129)
Baseline
1st quarter
2nd quarter
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15.1*
Mean Scores
15
10
12.7
13.5*
9
14.2 14.4*
13.5
8.3
14.6
15.6*
9.6
9.6
Social
relationships
Environment
5
0
Physical health
Psychological
*p<0.001
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METHADONE ANONYMOUS (MA) MEETING
• Three MA groups formed in
three different areas of
Dhaka
• Since June 2011,
fortnightly MA meetings
are being conducted
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ACKNOWLEDGEMENT
All beneficiaries and participants
Self help groups of PWUD
DNC
NASP
UNODC
fhi360
THANK YOU
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