New WHO guidelines on TB/HIV services for drug users

WHO has released the following new document:

POLICY GUIDELINES FOR COLLABORATIVE TB AND HIV SERVICES FOR INJECTING AND OTHER DRUG USERS AN INTEGRATED APPROACH

Our IDU programs should be looking for ways to actively link our IDU clients with TB services. This document outlines best practices on how to do this, and more.

You can download it at: http://www.psi.org//HIV/tools/Collaborative%20TB%20HIV%20Services%20IDUs.pdf

Rob

What Global Fund Wants to See in Proposals

In the latest edition of the Global Fund Observer (available at www.aidspan.org), there is a short article outlining what GF wants to see in proposals. Especially for people in countries applying in Round 9, reading this will be 3 minutes well spent. (see below)

Rob



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1. NEWS: TRP Provides Important Guidance on What it Wants to See in Proposals

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The Fund’s Technical Review Panel (TRP) has provided some important guidance on what can lead it to recommend that a Global Fund proposal be funded or not funded. This guidance, which is much more explicit than the TRP has provided in the past, is buried deep in a report prepared for last month’s Global Fund Board meeting. The report, entitled, "Report of the Technical Review Panel and the Secretariat on Round 8 Proposals," is available under "TRP Report to the Board" at www.theglobalfund.org/en/board/meetings/eighteenth/documents.



In the report, the TRP listed a number of factors that it said constitute "the minimum fundamental prerequisites for a recommendation for funding."



Although the prerequisites listed below have not been adopted as formal Global Fund policy, they nevertheless constitute important guidance for applicants preparing proposals for Round 9 (and beyond) because they provide insight into the way the TRP evaluates proposals.



The prerequisites listed by the TRP (and we quote them exactly as written) are as follows:

A disease proposal that is based upon and responds directly to the current, documented, epidemiological situation;

A coherent strategy that flows in a consistent order throughout the proposal – with the implementation plans having the same objectives, program areas ('Service Delivery Areas'), and interventions/activities as are stated in the budget, the work plan, the 'Performance Framework';

A robust gap analysis, both programmatic and financial, that accounts for the full extent of existing resources (including those planned and/or reasonably anticipated based on past practice) and not merely signed arrangements;

Clear and realistic analysis of implementation and absorptive capacity constraints (whether disease specific or broader health systems) that relate directly to the in-country social, environmental and other contexts;

Logical strategies to address capacity constraints, whether through the existing funding application, or through other domestic or partner supported initiatives (which are also subject to performance assessments and adjustments);

Implementation arrangements that recognize and respond to the need to broaden service delivery channels to multiple sectors to achieve universal access to prevention, treatment, and care and support services for people most affected;
Demonstrated effort to address the more challenging drivers of, especially, the HIV epidemic in ways that will have a meaningful impact on preventing further infections;

A clear plan for how to monitor activities and evaluate the impact of interventions;
A budget that is sufficiently detailed to allow the costs of activities to be assessed;

A workplan that makes clear the timing and sequencing of activities and responsibilities for each activity;

and
Planned outcomes (included as indicators in the 'Performance Framework') that address and respond to current epidemiological data, and demonstrate that the incremental investment of additional Global Fund resources will improve disease specific and broader health outcomes for those most at risk.


The TRP said that by dealing effectively with all these prerequisites, an applicant will demonstrate to the TRP that it "has a clear need for the additional resources, and has planned its funding request in a way that will supplement and strengthen in-country responses to the three diseases."



Significantly, the TRP added that "addressing weaknesses in earlier 'Category 3' proposals is also an important, but not determining factor, as to whether a proposal is recommended for funding."



The TRP went on to provide a number of observations on Round 8 proposals. These are discussed in the next article.

Confirmation that methadone in prison reduces infection risk

From Australia the first trial to randomly allocate prisoners seeking this treatment to methadone maintenance - important, because previous trials could not eliminate the possibility that outcomes were simply due to promising cases self-selecting for treatment. Making this option available led to substantial reductions in heroin use, injecting and syringe sharing. Print publication 2004 [Drug and Alcohol Findings, UK]

http://findings.org.uk/docs/nug_10_8.pdf

First randomised trial of needle exchange

First randomised trial of needle exchange

Alaskan needle exchanges passed an unusually stringent test of whether they improved on simply enabling injectors to buy equipment from pharmacies. Risky injecting was reduced without increasing (and if anything reducing) injecting frequency and cocaine use. Print publication 2004 [Drug and Alcohol Findings, UK]


http://findings.org.uk/docs/nug_10_7.pdf

2009 Harm Reduction Conference - Update

Over the past few months, there has been a lot of hard work behind the scenes in planning for Harm Reduction 2009 – www.ihraconferences.net – and the Conference Director, Professor Gerry Stimson, has written an open letter to everyone interested in the event in order to update our colleagues on some of the significant developments.

http://www.ihra.net/Thailand/News#AnOpenLetterfromProfessorStimson,ConferenceDirector

Initiating IDU

A new paper on youth initiation of IDU is out. Details below.

We'll try to have the paper available on the PSI IDU site later this week.

Rob




AIDS and Behavior, Volume 12, Number 6 / November, 2008
Original Paper
Initiators: An Examination of Young Injecting Drug Users Who Initiate Others to Injecting

Joanne Bryant1 and Carla Treloar1

(1)
National Centre in HIV Social Research, University of New South Wales, Sydney, NSW, 2052, Australia


Received: 4 July 2007 Accepted: 3 December 2007 Published online: 21 December 2007

Abstract



Research about initiation to injecting drugs emphasises the role that relationships with others plays in the experience, suggesting investigations of initiation should include an examination of both initiates and initiators. This paper uses cross-sectional data collected from 324 young, early-career injecting drug users (IDU) to describe the socio-demographic characteristics, drug and injecting practices, and harm reduction knowledge and practices of people who report initiating others to injecting. Fifty-five participants (17%) reported giving someone else their first injection. They reported initiating a total of 128 other people within the first 5 years of their own injecting. Compared to non-initiators, initiators were more likely to pass on harm reduction information [odds ratios (OR): 2.36, 95% confidence intervals (CI): 1.26–4.40]. However, the quality of this information was unknown and initiators did not have more accurate knowledge of blood borne viruses (BBV) than non-initiators, and commonly obtained needles and syringes from sources where the sterility of the equipment could not be guaranteed.

New Tool from FHI

FHI has released "Treatment and Care for HIV-Positive Injecting Drug Users: Training Course." The training manual covers a wide variety of topics, including information about dependence, coinfection, psychosocial care and ART.

The manual is available online at http://www.fhi.org/training/en/HIVAIDS/IDUModules/index.htm.

Thanks