Abstract
Background and aimsDespite 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 resultsThe 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.ConclusionsThe 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.
Highlights
Background and aimsDespite 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
The Global Research Network (GRN) was succeeded in 2004 by the ‘Reference Group to the United Nations on human immunodeficiency virus (HIV) and Injecting Drug Use’, a network funded by UNODC, World Health Organization (WHO) and The Joint United Nations Programme on HIV/AIDS (UNAIDS), to estimate the global spread of HIV among people who inject drugs (PWID) [71–73] and intervention coverage [13] using common methodology, which culminated in UN guidance for countries to set targets for intervention coverage [6, 74] and implementation [75]
Results of the expert group consultation During 2014 and 2015, an international expert network began discussions to advance the monitoring and evaluation of best practice in drug-related interventions in Europe. It recommended focusing on the monitoring of coverage and quality of harm reduction services, as a first step to improving best practice implementation of wider drug services
Summary
Background and aimsDespite 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. Important advances in interventions for people who use drugs (PWUD), in particular those who use opioids and people who inject drugs (PWID), have occurred over recent decades Harm reduction services such as needle and syringe programmes (NSP) and opioid agonist therapy (OAT) [1] have been increasingly established, with 90 countries having NSP to some degree and 80 at least one OAT programme operational by 2016 [2]. This has contributed to reductions in viral infections (e.g. human immunodeficiency virus (HIV), hepatitis C virus (HCV)) and bacterial infections (e.g. tuberculosis (TB), sexually transmissible infections, skin infections), crime, overdose and mortality among PWUD. Evidence on intervention best practice is mounting and is increasingly based on larger and better designed studies [23, 24]
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