Author:
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Wiessing, Lucas; Ferri, Marica; Belackova, Vendula; Carrieri, Patrizia; Friedman, Samuel R.; Folch, Cinta; Dolan, Kate; Galvin, Brian; Vickerman, Peter; Lazarus, Jeffrey V.; Mravcik, Viktor; Kretzschmar, Mirjam; Sypsa, Vana; Sarasa-Renedo, Ana; Uuskula, Anneli; Paraskevis, Dimitrios; Mendao, Luis; Rossi, Diana; Gelder, Nadine van; Mitcheson, Luke; Paoli, Letizia; Diaz Gomez, Cristina; Milhet, Maitena; Dascalu, Nicoleta; Knight, Jonathan; Hay, Gordon; Kalamara, Eleni; Simon, Roland; Comiskey, Catherine; Rossi, Carla; Griffiths, Paul
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Abstract:
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BACKGROUND AND AIMS: Despite advances in our knowledge of
effective services for people who use drugs over the last
decades globally, coverage remains poor in most countries, while
quality is often unknown. This paper aims to discuss the
historical development of successful epidemiological indicators
and to present a framework for extending them with additional
indicators of coverage and quality of harm reduction services,
for monitoring and evaluation at international, national or
subnational levels. The ultimate aim is to improve these
services in order to reduce health and social problems among
people who use drugs, such as human immunodeficiency virus (HIV)
and hepatitis C virus (HCV) infection, crime and legal problems,
overdose (death) and other morbidity and mortality. METHODS AND
RESULTS: The framework was developed collaboratively using
consensus methods involving nominal group meetings, review of
existing quality standards, repeated email commenting rounds and
qualitative analysis of opinions/experiences from a broad range
of professionals/experts, including members of civil society and
organisations representing people who use drugs. Twelve priority
candidate indicators are proposed for opioid agonist therapy
(OAT), needle and syringe programmes (NSP) and generic
cross-cutting aspects of harm reduction (and potentially other
drug) services. Under the specific OAT indicators, priority
indicators included 'coverage', 'waiting list time', 'dosage'
and 'availability in prisons'. For the specific NSP indicators,
the priority indicators included 'coverage', 'number of
needles/syringes distributed/collected', 'provision of other
drug use paraphernalia' and 'availability in prisons'. Among the
generic or cross-cutting indicators the priority indicators were
'infectious diseases counselling and care', 'take away
naloxone', 'information on safe use/sex' and 'condoms'. We
discuss conditions for the successful development of the
suggested indicators and constraints (e.g. funding, ideology).
We propose conducting a pilot study to test the feasibility and
applicability of the proposed indicators before their scaling up
and routine implementation, to evaluate their effectiveness in
comparing service coverage and quality across countries.
CONCLUSIONS: The establishment of an improved set of validated
and internationally agreed upon best practice indicators for
monitoring harm reduction service will provide a structural
basis for public health and epidemiological studies and support
evidence and human rights-based health policies, services and
interventions. |