Abstract
Coverage is an important dimension in measuring the effectiveness of needle and syringe programmes in providing sterile injecting equipment for people who inject drugs. The World Health Organization (WHO), the United Nations Office on Drugs and Crime (UNODC) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) currently recommend methods for measuring coverage at the population level, that is, across an estimated population of people who inject drugs within a given geographical area. However, population-level measures of coverage rely on highly uncertain population estimates and cannot capture the different levels of syringe acquisition and injecting episodes among individual users. Consequently, such measures only broadly evaluate the extent of programme service delivery, rather than describe how people who inject drugs as individuals and sub-groups interact with needle and syringe programmes. In response to these limitations, several researchers have proposed measuring coverage at the individual level, by the percentage of injecting episodes in relation to the number of sterile needles and syringes acquired. These measures evaluate coverage according to each individual’s needs. Such measures provide enhanced information for planning and monitoring of harm reduction programmes and have now been used in multiple international research studies. We advise that WHO, UNODC and UNAIDS add individual-level coverage measurement methods to their international monitoring guidelines for harm reduction programmes. By doing this, more responsive and effective programmes can be created to better reduce injecting risk behaviours and blood-borne virus transmission among people who inject drugs.
Highlights
Coverage is an important concept in the evaluation of any public health intervention and coverage has been defined as “the proportion of the population at risk reached by an intervention, ideally with sufficient intensity to have probable impact.”[1]. Historically associated with communicable disease control and immunization programmes,[2] coverage provides a means of assessing programmatic effectiveness and developing performance targets
Syringe coverage can be measured at the population level or the individual level and these levels suit specific purposes in programmatic monitoring.[2]
In this paper we explore the development of syringe programme coverage measurement at the individual level, its previous international implementation and the practical considerations and limitations of its use
Summary
Coverage is an important concept in the evaluation of any public health intervention and coverage has been defined as “the proportion of the population at risk reached by an intervention, ideally with sufficient intensity to have probable impact.”[1]. As standard monitoring and evaluation indicators, these populationlevel methods and targets are widely recognized and used.[10,24] The methods have obvious limitations, The measures of both reach and need rely on estimates of the population of people who inject drugs, which are always uncertain.[25,26] The measure of reach is reliant on system-wide registration to capture repeat visits by clients,[26] a practice common to some countries[2] but not all. In some Australian jurisdictions, needle and syringe programme data include questions to clients about their demographic profile and drug preferences.[40] Additional questions about injection risk behaviour (e.g. syringe sharing) could be included and compared against coverage levels, providing an indication of risk profiles, albeit less detailed than in the multiple, international primary research studies described above. Individual-level coverage measurement should be used to monitor the quality of service delivery and identify sub-groups of people who inject drugs in need of tailored, targeted intervention
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