Dr. Nandira Changkija, Project Director, Nagaland State AIDS Control Society (NSACS) called for a renewed commitment from stakeholders and the setting up of a committee of officials and civil society to ensure scale up of Opioid Substitution Therapy (OST) for Injecting Drug Users (IDUs) in the north eastern states. She stressed on the importance of information and knowledge sharing to make the OST program scale up a success story in the region. “It’s I, you and we who are failing to implement.
We need to share information for such a scale up and more importantly we need to involve all the stake holders.” She was speaking at a north east states consultation for dissemination of experiences of NGO-led OST in Manipur and Nagaland implemented by Project ORCHID.
Dr. Shailesh Kumar Chaurasia, IAS, project director, Manipur State AIDS Control Society (MSACS), Dr. Nandira Changkija, Project Director, Nagaland State AIDS Control Society (NSACS), representatives of NACO-NERO, Guwahati, drug users and positive networks and NGO working in the field of drugs and HIV & AIDS attended the day long Consultation organised by Project ORCHID.
In addition, officials from State AIDS Control Societies (SACS) in Assam, Meghalaya, Nagaland, Tripura and Mizoram also attended the consultation to learn from the experiences of the OST roll out in Manipur and Nagaland through community – NGO partnerships.
Speaking on the occasion Dr. Shailesh Kumar Chaurasia, IAS, Project Director, Manipur State AIDS Control Society (MSACS) said “Opioid Substitution Therapy or OST is the best option today for injecting drug users and we will do whatever we can to scale it up”.
In 2005, WHO added Methadone and Buprenorphine to its list of essential medicines, and by 2010, 70 countries were implementing OST programmes as part of their harm reduction and HIV prevention strategy. Despite WHO and UN agency endorsement for OST, it is estimated that only 8% of People who inject Drugs receive OST worldwide. Hence today there is an urgent need to learn from the successful experiences of programs implementing OST and replicate it in similar settings.
In India, OST was introduced in 1993 and in Manipur and Nagaland Project ORCHID OST initiatives began in 2006. In Nagaland the OST clinics were implemented by Project ORCHID partner NGOs. 13 OST clinics have reached out to 1800 IDUs across Manipur and Nagaland through Project ORCHIDs initiatives.
Results from Project ORCHID’s experience of NGO and community partnership OST clinics in Manipur and Nagaland indicate that the program has achieved a very high regular attendance rate (91% recorded in 2011). This is due to high community involvement, comprehensive outreach services, strong counselling and a continued emphasis on family involvement and support.
Secondly, there has been a substantial improvement in the health practices of the IDUs who were reporting less risk behaviour as compared to before being on OST. It was also found that the quality of life of drug users on OST was showing a substantial improvement. They were attending social events, experiencing lesser family conflicts and there were lesser instances of incarceration and work absenteeism.
Speaking on the importance of continued scale up, Dr. Langkham, Director, EHA-HIV&AIDS and Partnership Projects stated, “A day of sobriety in the life of a drug user is important. When we started OST people questioned us on the chances of success of the program? The programme was for one year. Today not only are OST services continuing but it is being seen as an important treatment option by the community of injecting drug users. We have achieved ten percent OST coverage in Manipur and aim to reach 20 percent soon”.
A key feature of the Project ORCHID experience has been partnerships with the IDU community, which has enabled the program to show results. Reiterating the need for community involvement Dr. Suresh, consultant, said that OST is one of the priority for NACO and an effective way of community involvement is being worked out. “Single agency implementation of OST will not work; it has to be collaborative with involvement of various government and non government players at various levels.”
As part of the proposed scale up in Manipur, the Manipur State AIDS Control Society (MSACS) is assessing 19 sites where OST centres can be set up. Four sites in Thoubal, Tamenglong, Moreh in Chandel district and Senapati have been approved and the centre in Senapati is already operational.
In this regard Dr. Chaurasia underlined the importance of the OST program for the North East states, “We can’t be content with NSEP and have to engage in various levels. OST today is emerging as the most effective and accepted option among IDUs.”
In Nagaland, in addition to the existing OST sites supported by Project ORCHID and Nagaland State AIDS Control Society, the National AIDS Control Organisation has plan to set up more sites in government health care settings. OST clinics have been set up in district hospitals in Kiphiri, Wokha and Mokochung.
OST clinics have been approved in Longleng, Tuensang, Peren, Zunheboto and Mon district hospitals. 19 more OST clinics are also being set up in PHC and CHCs in these districts mentioned after a feasibility study report of the sites is submitted to NACO by the end of the month.
Stressing on the partnerships developed to implement a program of this scale, Dr. Suresh mentioned, “An important aspect of the ORCHID experience is that they haven’t worked in isolation but in partnership with the government” Referring to the Australian experience where OST coverage among IDU is 40 to 50 percent Dr. Suresh said that HIV prevalence among IDUs in Australia reduced drastically with increase in OST coverage. “We have to be able to achieve 30 – 40 percent coverage to reduce incidence of HIV among IDUs”. He further emphasised on the need for OST services to be extended to women, “It is even more important considering their vulnerability”.
SACS officials from the north east states shared their experiences of rolling out OST in their states. Community representatives also shared the impact that the OST program had on their lives.
As a graduate student Gyanjyoti relapsed on numerous occasions, however after enrolling in OST programme he continued his studies and completed his degree in 2007. He is currently pursuing research from Manipur University. Gyanjyoti started OST in 2006 at the OST centre in Manipur Network of Positive People (MNP+), Imphal.
Melody (name changed), whose husband is currently undergoing OST in Churachandpur district, said she came to know of her husband’s drug use in 2002. Quarrels were frequent and her husband used to sell household goods to support his habit. The ORCHID OST programme in Churachandpur has however enabled him to stay off drugs and take more interest in other productive activities.