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1.
Harm Reduct J ; 14(1): 38, 2017 06 14.
Artigo em Inglês | MEDLINE | ID: mdl-28615077

RESUMO

BACKGROUND: WHO, UNODC, and UNAIDS recommend a comprehensive package for prevention, treatment, and care of HIV among people who inject drugs (PWID). We describe the uptake of services and the cost of implementing a comprehensive package for HIV prevention, treatment, and care services in Delhi, India. METHODS: A cohort of 3774 PWID were enrolled for a prospective HIV incidence study and provided the comprehensive package: HIV and hepatitis testing and counseling, hepatitis B (HB) vaccination, syndromic management of sexually transmitted infections, clean needles-syringes, condoms, abscess care, and education. Supplementary services comprising tea and snacks, bathing facilities, and medical consultations were also provided. PWID were referred to government services for antiretroviral therapy (ART), TB care, opioid substitution therapy, and drug dependence treatment/rehabilitation. RESULTS: The project spent USD 1,067,629.88 over 36 months of project implementation: 1.7% on capital costs, 3.9% on participant recruitment, 26.7% for project management, 49.9% on provision of services, and 17.8% on supplementary services. Provision of HIV prevention and care services cost the project USD 140.41/PWID/year. 95.3% PWID were tested for HIV. Of the HIV-positive clients, only 17.8% registered for ART services after repeated follow-up. Reasons for not seeking ART services included not feeling sick, need for multiple visits to the clinic, and long waiting times. 61.8% of the PWID underwent HB testing. Of the 2106 PWID eligible for HB vaccination, 81% initiated the vaccination schedule, but only 29% completed all three doses, despite intensive follow-up by outreach workers. PWID took an average of 8 clean needles-syringes/PWID/year over the project duration, with a mid-project high of 16 needles-syringes/PWID/year. PWID continued to also procure needles from other sources, such as chemists. One hundred five PWID were referred to OST services and 267 for rehabilitation services. CONCLUSIONS: A comprehensive HIV prevention, treatment, and care package is challenging to implement. Extensive efforts are needed to ensure the uptake of and retention in services for PWID; peer educators and outreach workers are required on a continuous basis. Services need to be tailored to client needs, considering clinic timing and distance from hotspots. Programs may consider provision of ART services at selected drop-in centers to increase uptake.


Assuntos
Usuários de Drogas , Infecções por HIV/prevenção & controle , Abuso de Substâncias por Via Intravenosa/complicações , Adulto , Terapia Antirretroviral de Alta Atividade/economia , Estudos de Coortes , Relações Comunidade-Instituição , Preservativos/economia , Custos e Análise de Custo , Feminino , Infecções por HIV/economia , Infecções por HIV/terapia , Redução do Dano , Hepatite B/prevenção & controle , Hepatite C/prevenção & controle , Humanos , Índia , Masculino , Programas de Troca de Agulhas/economia , Programas de Troca de Agulhas/legislação & jurisprudência , Tratamento de Substituição de Opiáceos/economia , Estudos Prospectivos , Fatores Socioeconômicos , Abuso de Substâncias por Via Intravenosa/reabilitação
2.
Harm Reduct J ; 10: 16, 2013 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-24063610

RESUMO

BACKGROUND: We utilized multiple recruitment approaches to recruit IDUs in a longitudinal cohort study to examine HIV incidence and behavior change pre- and post-introduction of comprehensive HIV prevention services. METHODS: IDUs were recruited through peer referral, targeted outreach by outreach workers (ORWs) and as walk-in clients at drop-in centers. Participants received monetary compensation for participation (USD 0.80). Participants were given recruitment coupons to recruit peers (regardless of recruitment method). For peer referral, participants received a food coupon, as secondary compensation, for each peer he/she successfully recruited. We report the profile of IDUs by recruitment method, based on the baseline behavioral survey and HIV test results. Cost per IDU recruited by recruitment method was also calculated. RESULTS: A total of 3,818 IDUs were recruited between May 2011 and October 2011. More than half of the study participants were recruited through targeted outreach (ORW: 53.6%; peer-referral: 26.3%; walk-ins: 20.1%). Of the participants who were given recruitment coupons, 92.7% recruited no peers. Those who successfully recruited at least one peer were significantly more likely to be in a stable living accommodation compared to those who did not recruit any peers (51.1% versus 42.7%; p < 0.05). Only 45.9% of the food coupons were claimed for successful recruitment of peers. Peer-referred IDUs were more likely to be living with family or relatives (50.7% versus ORW: 40.1% and walk-in: 39.8%; p < 0.001) rather than on the street or shared housings compared to the other two recruitment modes. Walk-ins were more likely than peer-referred and ORW-referred IDUs to be HIV-positive (walk-ins: 26.1%; peer-referred: 19.1%; ORW: 19.9%; p < 0.01) and have risky injection practices (walk-ins: 62.2%; ORW: 57.0%; peer-referred: 58.6%; p < 0.05). The cost per IDU recruited through ORW referral method was the most costly at USD 16.30, followed by peer-referral at USD 8.40 and walk-in at USD 7.50. CONCLUSION: When recruiting a large number of IDUs, using multiple recruitment modes is ideal with regard to diversification of IDU characteristics and risk profile. Although it was the most costly, ORW recruitment was more effective than the other two methods. Lack of monetary compensation for successful recruitment of peers may have hampered peer-referral.


Assuntos
Infecções por HIV/prevenção & controle , Seleção de Pacientes , Abuso de Substâncias por Via Intravenosa/reabilitação , Adulto , Assistência Ambulatorial/economia , Assistência Ambulatorial/estatística & dados numéricos , Distribuição de Qui-Quadrado , Custos e Análise de Custo , Feminino , Infecções por HIV/economia , Redução do Dano , Humanos , Índia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Motivação , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Abuso de Substâncias por Via Intravenosa/economia , Inquéritos e Questionários
3.
Int Perspect Sex Reprod Health ; 38(2): 68-77, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22832147

RESUMO

CONTEXT: The Indian family planning program, though successful in increasing contraceptive use among couples who have achieved their desired family size, has not been equally successful in educating couples about the use of contraceptive methods for birth spacing. METHODS: An evaluation was conducted of a behavior change communication intervention integrated into the existing government program to increase knowledge and use of the lactational amenorrhea method and postpartum contraception through counseling by community workers. The intervention, which ran between September 2006 and January 2007, was conducted among 959 pregnant women aged 15-24 who lived in Uttar Pradesh, India. The evaluation used logistic regression analyses to measure differences in knowledge and contraceptive use between baseline and the four- and nine-month postpartum follow-up surveys within and between the intervention and comparison groups. RESULTS: The follow-up data show increases in knowledge of the lactational amenorrhea method and spacing methods and in use of spacing methods. At four months postpartum, women in the intervention group were more likely to know the healthy spacing messages than those in the comparison group (odds ratio, 2.1). At nine months postpartum, women in the intervention group, those with higher knowledge of healthy spacing practices and those with correct knowledge of two or more spacing methods were more likely than others to be using a contraceptive method (1.5-3.5). Use of modern contraceptives for spacing at nine months postpartum was 57% in the intervention group versus 30% in the comparison group. CONCLUSIONS: Targeted behavior change communication using community workers is an effective and feasible strategy for promoting postpartum contraception.


Assuntos
Agentes Comunitários de Saúde/tendências , Anticoncepção/métodos , Serviços de Planejamento Familiar/métodos , Conhecimentos, Atitudes e Prática em Saúde , Lactação/fisiologia , Adolescente , Amenorreia/etiologia , Intervalo entre Nascimentos/estatística & dados numéricos , Agentes Comunitários de Saúde/educação , Anticoncepção/estatística & dados numéricos , Anticoncepção/tendências , Escolaridade , Serviços de Planejamento Familiar/tendências , Feminino , Educação em Saúde/métodos , Humanos , Período Pós-Parto , Gravidez , Avaliação de Programas e Projetos de Saúde , Saúde da População Rural , Fatores Socioeconômicos , Recursos Humanos , Adulto Jovem
4.
AIDS Behav ; 16(4): 952-9, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22186960

RESUMO

This paper examines the relationship between indicators of mobility, socio-economic vulnerabilities, and HIV risk behaviours among 5,498 mobile female sex workers (FSWs) living in the four high HIV prevalence states in India. Female sex workers with greater degree of mobility reported significantly more often than the FSWs with lesser degree of mobility that they experienced physical violence, and consumed alcohol prior to sex. Further, FSWs with greater degree of mobility reported significantly more often than the FSWs with lesser degree of mobility that they had inconsistent condom use in sex with clients, even after controlling for several demographic characteristics and socio-economic vulnerabilities including experiences of violence. Additionally, short duration visits and visit to the Jatra (religious fairs) places found to have significant association with their inconsistent condom use in sex with clients as well as continuation of sex despite having STI symptoms. These findings suggest the need for screening FSWs for higher degree of mobility and to mobilize them to form community networks so as to deal with violence, reduce alcohol use and promote consistent condom use along the routes of mobility. HIV prevention interventions aimed at FSWs require an increased attention to address the socio-economic vulnerabilities including alcohol use, with particular emphasis on those FSWs who are on the move in India and elsewhere.


Assuntos
Preservativos/estatística & dados numéricos , Soropositividade para HIV/epidemiologia , Profissionais do Sexo/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Sexo sem Proteção/estatística & dados numéricos , Adolescente , Adulto , Feminino , Soropositividade para HIV/transmissão , Humanos , Índia/epidemiologia , Prevalência , Assunção de Riscos , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
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