Home > Monitoring quality and coverage of harm reduction services for people who use drugs: a consensus study.

Wiessing, Lucas and Ferri, Marica and Běláčková, Vendula and Carrieri, Patrizia and Friedman, Samuel R and Folch, Cinta and Dolan, Kate and Galvin, Brian and Vickerman, Peter and Lazarus, Jeffrey V and Mravčík, Viktor and Kretzschmar, Mirjam and Sypsa, Vana and Sarasa-Renedo, Ana and Uusküla, Anneli and Paraskevis, Dimitrios and Mendão, Luis and Rossi, Diana and van Gelder, Nadine and Mitcheson, Luke and Paoli, Letizia and Gomez, Cristina Diaz and Milhet, Maitena and Dascalu, Nicoleta and Knight, Jonathan and Hay, Gordon and Kalamara, Eleni and Simon, Roland and Comiskey, Catherine and Rossi, Carla and Griffiths, Paul (2017) Monitoring quality and coverage of harm reduction services for people who use drugs: a consensus study. Harm Reduction Journal , 14 , (1) , p. 19.

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.


Item Type:Article
Date:2017
Page Range:p. 19
Publisher:BioMed Central
Volume:14
Number:1
EndNote:View
Accession Number:HRB (Electronic Only)
Related URLs:
Subjects:J Health care, prevention and rehabilitation > Substance use prevention > Substance use harm reduction
J Health care, prevention and rehabilitation > Health care programme or facility
VA Geographic area > International aspects
VA Geographic area > Europe

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