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Abstract Details |
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Monitoring quality and coverage of harm reduction services for people who use drugs: a consensus study |
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Wiessing L1, Ferri M2, Běláčková V3,4,5, Carrieri P6,7, Friedman SR8, Folch C9,10, Dolan K11, Galvin B12, Vickerman P13, Lazarus JV14,15, Mravčík V3,4,16, Kretzschmar M17,18, Sypsa V19, Sarasa-Renedo A10,20, Uusküla A21, Paraskevis D19, Mendão L22, Rossi D23, van Gelder N2, Mitcheson L24, Paoli L25,26, Gomez CD27, Milhet M27, Dascalu N28, Knight J29, Hay G30, Kalamara E2, Simon R2; EUBEST working group, Comiskey C31, Rossi C32, Griffiths P2. Harm Reduct J. 2017 Apr 22;14(1):19. doi: 10.1186/s12954-017-0141-6. |
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Collaborators (26)
Author information
1
European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Praça Europa 1, Cais do Sodré, 1249-289, Lisbon, Portugal. Lucas.Wiessing@emcdda.europa.eu.
2
European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Praça Europa 1, Cais do Sodré, 1249-289, Lisbon, Portugal.
3
Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.
4
National Institute for Mental Health, Prague, Czech Republic.
5
Uniting Medically Supervised Injecting Centre, Sydney, Australia.
6
Marseille Univ, INSERM, IRD, SESSTIM, Marseille, France.
7
ORS PACA, Marseille, France.
8
Institute of Infectious Disease Research, National Development and Research Institutes, New York, USA.
9
Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya (ASPC), Barcelona, Spain.
10
Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.
11
Program of International Research and Training, National Drug and Alcohol Research Centre, The University of New South Wales (UNSW), Sydney, Australia.
12
Health Research Board, Dublin, Ireland.
13
School of Social and Community Medicine, University of Bristol, Bristol, UK.
14
CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
15
Barcelona Institute of Global Health (ISGlobal), Hospital Clinic, University of Barcelona, Barcelona, Spain.
16
National Monitoring Centre for Drugs and Addiction, Prague, Czech Republic.
17
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
18
Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
19
Department of Hygiene Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
20
Spanish Field Epidemiology Training Program (PEAC), National Centre of Epidemiology, Carlos III Health Institute, Madrid, Spain.
21
Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
22
Group of Activists on Treatments (GAT), Lisbon, Portugal.
23
Intercambios Civil Association and University of Buenos Aires, Buenos Aires, Argentina.
24
Alcohol, Drug, and Tobacco Division, Health and Wellbeing Directorate, Public Health England, London, UK.
25
Leuven Institute of Criminology (LINC), Faculty of Law, University of Leuven, Leuven, Belgium.
26
Centre for Global Governance Studies (GSS), Leuven, Belgium.
27
French Monitoring Centre for Drugs and Drug Addiction (OFDT), Saint-Denis, France.
28
The Romanian Association Against AIDS (ARAS), Bucharest, Romania.
29
Department of Health, Wellington House, London, UK.
30
Public Health Institute, Faculty of Education, Health and Community, Liverpool John Moores University, Liverpool, UK.
31
Trinity College Dublin, The University of Dublin, Dublin, Ireland.
32
Centro Studi Statistici e Sociali CE3S, Rome, Italy.
Abstract
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.
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