the essential package paul williams united nations office on drugs and crime vienna master class,...
TRANSCRIPT
The Essential Package
Paul WilliamsUnited Nations Office on Drugs and Crime
Vienna
Master Class, YaltaSeptember 2007
From the ‘Comprehensive’ to the ‘Essential’ Package: Core service coverage indicators
1 July 2005
“The position paper is grounded in a number of essential principles crucial to the success of any
effective HIV prevention effort.”
3. Preventing transmission of HIV through injecting drug use
• Full range of treatment options (notably ST)
• Implementation of harm reduction measures
(through among others…- peer outreach- NSP)
• VCT – new - PICT
• Prevention of sexual transmission (including condoms and STI treatment)
• Access to primary health care
• Access to ARVs
The comprehensive package (vers. 1)
Operationalising the package at field level
The comprehensive package (vers. 2)
• IEC
• Condoms
• ST
• NSP
• VCT
• ARVs
• STIs
• ADAS
June 2006
• UNODC convened a meeting of ~ 39 international experts in Vienna – charged with reviewing the Comprehensive Package, with respect to resource poor, developing and in-transition countries
June 2006
• UNODC convened a meeting of ~ 39 international experts in Vienna – charged with reviewing the Comprehensive Package, with respect to resource poor, developing and in-transition countries
• Also charged with identifying which elements of the CP were “ Essential” and which ones were “added value” .
Comprehensive
• IEC
• Condoms
• ST
• NSP
• VCT
• ARVs
• STIs
• ADAS
•
• • ST
• NSP
• VCT
• ARVs
•
•
Essential
Comprehensive
• IEC
• Condoms
• ST
• NSP
• VCT
• ARVs
• STIs
• ADAS
•
•
• ST
• NSP
• VCT
• ARVs
•
•
Essential Measuring the EP
•
• ~Condoms~
• ST
• NSP
• VCT
• ARVs
•
•
Comprehensive
• IEC
• Condoms
• ST
• NSP
• VCT
• ARVs
• STIs
• ADAS
•
•
• ST
• NSP
• VCT
• ARVs
•
•
Essential Measuring the EP
•
• ~Condoms~
• ST
• NSP
• VCT
• ARVs
• ~STIs~
•
•
• • ST
• NSP
• VCT
• ARVs
•
Essential
THE TWO GUIDING PRINCIPLES
1) While the Comprehensive Package provides optimal results, without at least the Essential Package of measures, efforts will fail
•
• • ST
• NSP
• VCT
• ARVs
•
Essential
THE TWO GUIDING PRINCIPLES
2) Even if we do implement the Comprehensive Package, we should make sure we at least measure the Essential Package
Impact, Coverage, Quality
Impact
Coverage
Quality
~Timing~
Impact
ONLY TWO INDICATORS MATTER
Reduction in incidence
Impact
ONLY TWO INDICATORS MATTER
Reduction in incidence
Survival (following diagnosis)
Quality
Generally, Measured at the technical level
- Standards…(e.g. WHO guidelines)
Quality
Generally, Measured at the technical level
- Standards…(e.g. WHO guidelines)
- Certification (e.g. min. of 3 years training)
Quality
Generally, Measured at the technical level
- Standards…(e.g. WHO guidelines)
- Certification (e.g. min. of 3 years training)
- Using proven effective medications etc.
Quality
Rarely is “client satisfaction”, “gender sensitivity”, “acceptance by neighbourhood”, “level of social
disruption/crime associated with facility” etc. measured as “QUALITY” indicators
Impact, Coverage, Quality
WHAT IF WE COULD USE COVERAGE AS A PROXY FOR MEASURING PROGRESS IN
“PROGRAMME ROLLOUT” to prevent transmission by injecting?
Impact, Coverage, Quality
WHAT IF WE COULD USE COVERAGE AS A PROXY FOR MEASURING PROGRESS IN
“PROGRAMME ROLLOUT” to prevent transmission by injecting?
And ignore for the time being, quality (which is poorly measured in any event), and impact (which
might take years to become evident)
Impact, Coverage, Quality
WHAT IF WE COULD USE COVERAGE AS A PROXY FOR MEASURING PROGRESS IN
“PROGRAMME ROLLOUT” to prevent transmission by injecting?
And ignore for the time being, quality (which is poorly measured in any event), and impact (which
might take years to become evident)
Also puts every country on equal reporting footing – don’t need sophisticated M&E system to track
Evaluation Framework
Objective
Principle Outcomes
Key outputs
Activities
Evaluation qns
Performance Indicators
(n=1)
(n=3)
(n=12)
(n=30)
(n=60+)
(n=150+)
Increase in
specificity
So – objective was CORE INDICATORS
Challenge: 5 core indicators across each of the three service areas:
• ST (methadone, buprenorphine)
• NSP
• Diagnosis and treatment
+ three summary indicators = total of 18 core indicators
And computations should be available continuously from routine data that are collected at service sites
First, look to existing indicators
UNGASS
Eight candidate indicators
4. Percentage of adults and children with advanced HIV infection receiving antiretroviral therapy
4. Percentage of adults and children with advanced HIV infection receiving antiretroviral therapy
• Not specific to IDU – (but could arrange for such a breakdown, though not required)
4. Percentage of adults and children with advanced HIV infection receiving antiretroviral therapy
• Not specific to IDU – (but could arrange for such a breakdown, though not required)
• Where IDU not driving epidemic, could have high % of non-IDU in receipt, and v.low, or no IDU receiving = (still) high % as a result
4. Percentage of adults and children with advanced HIV infection receiving antiretroviral therapy
• Not specific to IDU – (but could arrange for such a breakdown, though not required)
• Where IDU not driving epidemic, could have high % of non-IDU in receipt, and v.low, or no IDU receiving = (still) high % as a result
• Therefore, can hide discrimination against IDU, or ignore the potential for an IDU “breakout”
7. Percentage of women and men aged 15-49 who received an HIV test in the last 12 months and who
know their results
7. Percentage of women and men aged 15-49 who received an HIV test in the last 12 months and who
know their results
• Not specific to IDU (but could arrange for such a breakdown, though not required)
7. Percentage of women and men aged 15-49 who received an HIV test in the last 12 months and who
know their results
• Not specific to IDU (but could arrange for such a breakdown, though not required)
• Measurement by survey (and we know how difficult IDU are to reach) – not from actual service provision data
7. Percentage of women and men aged 15-49 who received an HIV test in the last 12 months and who
know their results
• Not specific to IDU (but could arrange for such a breakdown, though not required)
• Measurement by survey (and we know how difficult IDU are to reach) – not from actual service provision data• Computation is “Number tested and know results”/total tested
7. Percentage of women and men aged 15-49 who received an HIV test in the last 12 months and who
know their results
• Not specific to IDU (but could arrange for such a breakdown, though not required)
• Measurement by survey (and we know how difficult IDU are to reach) – not from actual service provision data• Computation is “Number tested and know results”/total tested
• So a country might have done just 10 tests of whom 9 knew their results (=90%), and another 100,000 tests, of whom 90,000 knew their results (also = 90%); but both are ranked equally in performance
8. Percentage of most at risk populations who received an HIV test in the last 12 months and who know their
results
8. Percentage of most at risk populations who received an HIV test in the last 12 months and who know their
results
• Measurement by SURVEILLANCE survey (but we know how difficult IDU are to reach)
8. Percentage of most at risk populations who received an HIV test in the last 12 months and who know their
results
• Measurement by SURVEILLANCE survey (but we know how difficult IDU are to reach)
• Computation is answers to qns (a) tested? And b) got results?
8. Percentage of most at risk populations who received an HIV test in the last 12 months and who know their
results
• Measurement by SURVEILLANCE survey (but we know how difficult IDU are to reach)
• Computation is answers to qns (a) tested? And b) got results?
• Same result problems (3/4 returns the same result of 75,000/100,000)
8. Percentage of most at risk populations who received an HIV test in the last 12 months and who know their
results
• Measurement by SURVEILLANCE survey (but we know how difficult IDU are to reach)
• Computation is answers to qns (a) tested? And b) got results?
• Same result problems (3/4 returns the same result of 75,000/100,000)
• PLUS, for both this and #7 – nothing in the indicator “requires” voluntary, confidential counselling
9. Percentage of most at risk populations with HIV prevention programmes
9. Percentage of most at risk populations with HIV prevention programmes
• Measurement by SURVEILLANCE survey (but we know how difficult IDU are to reach)
9. Percentage of most at risk populations with HIV prevention programmes
• Measurement by SURVEILLANCE survey (but we know how difficult IDU are to reach)
• Computation is individual and sum of answers to qns (a) know where to go for an HIV test? b) last 12 months given condoms [by IDU service]? And c) given sterile needle and syringes [by IDU service]?
9. Percentage of most at risk populations with HIV prevention programmes
• Measurement by SURVEILLANCE survey (but we know how difficult IDU are to reach)
• Computation is individual and sum of answers to qns (a) know where to go for an HIV test? b) last 12 months given condoms [by IDU service]? And c) given sterile needle and syringes [by IDU service]?
• 1 x condom; 1 x N&S is treated equally as 100 condoms and say, 300 needles and syringes
14. Percentage of most at risk populations who both correctly identify ways of preventing the sexual
transmission of HIV and who reject major misconceptions about HIV transmission
14. Percentage of most at risk populations who both correctly identify ways of preventing the sexual
transmission of HIV and who reject major misconceptions about HIV transmission
• Proxy for IEC coverage, but not specific to transmission by the injection route – important, but outside the scope of our intention
14. Percentage of most at risk populations who both correctly identify ways of preventing the sexual
transmission of HIV and who reject major misconceptions about HIV transmission
• Proxy for IEC coverage, but not specific to transmission by the injection route – important, but outside the scope of our intention
• PLUS – measures knowledge, not actual behavior change
20. Percentage of injecting drug users reporting the use of a condom the last time they had sexual
intercourse
20. Percentage of injecting drug users reporting the use of a condom the last time they had sexual
intercourse
• Proxy for IEC coverage, but not specific to transmission by the injection route – important, but outside the scope of our intention – nonetheless, we think about this one
20. Percentage of injecting drug users reporting the use of a condom the last time they had sexual
intercourse
• Proxy for IEC coverage, but not specific to transmission by the injection route – important, but outside the scope of our intention – nonetheless, we think about this one
• Measures actual behavior change, so good – another reason to think about it
20. Percentage of injecting drug users reporting the use of a condom the last time they had sexual
intercourse
• Proxy for IEC coverage, but not specific to transmission by the injection route – important, but outside the scope of our intention – nonetheless, we think about this one
• Measures actual behavior change, so good – another reason to think about it
• But, only applies to countries where injecting is an established mode – why not all countries?
21. Percentage of injecting drug users reporting the use of sterile injecting equipment the last time they
injected
21. Percentage of injecting drug users reporting the use of sterile injecting equipment the last time they
injected
• Surveillance survey (and we know how difficult IDU are to reach)
21. Percentage of injecting drug users reporting the use of sterile injecting equipment the last time they
injected
• Surveillance survey (and we know how difficult IDU are to reach)
• Proxy for actual coverage by NSP (in addition to knowledge), so why not measure actual coverage
23. Percentage of most at risk populations who are HIV infected
23. Percentage of most at risk populations who are HIV infected
• Very important, not a coverage indicator per se, but will be necessary as a denominator for say, ARV coverage
So, UNGASS summary
• Only two are actual coverage indicators (8 & 9) – but measurement/interpretation problems
So, UNGASS summary
• Only two are actual coverage indicators (8 & 9) – but measurement/interpretation problems
• 1 useful for coverage denominator purposes (23), but it is really an impact indicator (which itself is very good)
What about the Current Ukraine M&E plan
• Uses 7 core indicators from UNGASS, plus 2 “additionals”, including 1 replacement of one UNGASS core
indicator”
Additional # 1
VCT1 -Population requesting an HIV test, receiving a test and receiving test results
Additional # 1
VCT1 -Population requesting an HIV test, receiving a test and receiving test results
• This is the replacement for UNGASS, not specific to IDU, (but could arrange for such a breakdown, though not required)
Additional # 1
VCT1 -Population requesting an HIV test, receiving a test and receiving test results
• This is the replacement for UNGASS, not specific to IDU, (but could arrange for such a breakdown, though not required)
• Suffers from the same computational/interpretational problems previously identified
Additional # 2
VUL2 –Percentage of respondents in a survey of injecting drug users who, in response to prompting, identify switching to non-injectable drugs, avoiding sharing injecting equipment, and cleaning injecting
equipment with bleach as methods of preventing HIV transmission
Additional # 2
VUL2 –Percentage of respondents in a survey of injecting drug users who, in response to prompting, identify switching to non-injectable drugs, avoiding sharing injecting equipment, and cleaning injecting
equipment with bleach as methods of preventing HIV transmission
• (phew – quite a mouthful)
Additional # 2
VUL2 –Percentage of respondents in a survey of injecting drug users who, in response to prompting, identify switching to non-injectable drugs, avoiding sharing injecting equipment, and cleaning injecting
equipment with bleach as methods of preventing HIV transmission
Survey – community of IDU – good, but how many? representativeness etc.
Additional # 2
VUL2 –Percentage of respondents in a survey of injecting drug users who, in response to prompting, identify switching to non-injectable drugs, avoiding sharing injecting equipment, and cleaning injecting
equipment with bleach as methods of preventing HIV transmission
Prompting??? hmmm.
Additional # 2
VUL2 –Percentage of respondents in a survey of injecting drug users who, in response to prompting, identify switching to non-injectable drugs, avoiding sharing injecting equipment, and cleaning injecting
equipment with bleach as methods of preventing HIV transmission
Calculation = all three must be answered correctly, but bleach is a problem
Bleach
• Qn comes from UNAIDS 2000 publication
Bleach
• Qn comes from UNAIDS 2000 publication • WHO and UNODC (soon UNAIDS) no longer recommend bleach
Bleach
• Qn comes from UNAIDS 2000 publication • WHO and UNODC (soon UNAIDS) no longer recommend bleach
• So, someone who is up to date on the withdrawal of recommendation will not identify/report using bleach, just as someone who is not aware, but didn’t use it anyway
Bleach
• Qn comes from UNAIDS 2000 publication • WHO and UNODC (soon UNAIDS) no longer recommend bleach
• So, someone who is up to date on the withdrawal of recommendation will not identify/report using bleach, just as someone who is not aware, but didn’t use it anyway
• So indicator no longer accurate, and a proxy anyway, for actual coverage
Bleach
• Qn comes from UNAIDS 2000 publication • WHO and UNODC (soon UNAIDS) no longer recommend bleach
• So, someone who is up to date on the withdrawal of recommendation will not identify/report using use bleach, just as someone who is not aware, but didn’t use it anyway
• So indicator no longer accurate, and a proxy anyway, for actual coverage
Ukraine SUMMARY
Doesn’t add to what we got from UNGASS
CORE INDICATORS
Challenge: 5 core indicators across each of the three service areas:
• ST (methadone, buprenorphine)
• NSP
• Diagnosis and treatment
+ three summary indicators = total of 18 core indicators
And computations should be available continuously from routine data that are collected at service sites
Comprehensive
• IEC
• Condoms
• ST
• NSP
• VCT
• ARVs
• STIs
• ADAS
•
•
• ST
• NSP
• VCT
• ARVs
•
•
Essential Measuring the EP
•
• ~Condoms~
• ST
• NSP
• VCT
• ARVs
• ~STIs~
•
Summary measures
A) Elements (and year of introduction) of the essential package provided to IDU
B) Number and proportion of IDU service sites providing each element of the essential package
C) Number and proportion of IDU covered by each element of the Essential package
Summary measures
A) Elements (and year of introduction) of the essential package provided to IDU
First step – provide? y/n
ST NSP VCT ARVs All
x x
Summary measures
A) Elements (and year of introduction) of the essential package provided to IDU
Second step – Year of introduction
ST NSP VCT ARVs All
1998 - 2001 2003 -
Summary measures
B) Number and proportion of IDU service sites providing each element of the essential package
Begs the question – what is a “service site”?
And that is where the data dictionary comes in – it provides a guide – distinguishes between “fixed” and “mobile” sites
Summary measures
B) Number and proportion IDU service sites providing each element of the essential package
“proportion” requires knowing how many sites in total (as the denominator)
And this means public, private, ngos etc. So we need to know the sites.
Summary measures
B) Number and proportion IDU service sites providing each element of the essential package
NSP ST VCT ARVs All elements1
Kazakhstan 129 (NAC) 0 (0%) 659 (NAC) 22 (NAC) 0 (0%)
Kyrgyzstan 51 (NAC) 2 (NAC) 14 (NAC) 6 (NAC) 0 (0%)
Tajikistan 26 (NAC) n/a 140 (NAC) 7 (NAC) 0 (0%)
Turkmenistan NEA (NAC) n/a NEA (NAC) NEA (NAC) 0 (0%)
Uzbekistan 235 (99%) 1 (0.4%) 233 (98%) 2 (0.8%) 0 (0%)
NEA – No estimate available ; NAC – No estimate able to be computed (e.g. denominator missing)
Summary measures
B) Number and proportion IDU service sites providing each element of the essential package
NSP ST VCT ARVs All elements1
Kazakhstan 129 (NAC) 0 (0%) 659 (NAC) 22 (NAC) 0 (0%)
Kyrgyzstan 51 (NAC) 2 (NAC) 14 (NAC) 6 (NAC) 0 (0%)
Tajikistan 26 (NAC) n/a 140 (NAC) 7 (NAC) 0 (0%)
Turkmenistan NEA (NAC) n/a NEA (NAC) NEA (NAC) 0 (0%)
Uzbekistan 235 (99%) 1 (0.4%) 233 (98%) 2 (0.8%) 0 (0%)
NEA – No estimate available ; NAC – No estimate able to be computed (e.g. denominator missing)
Summary measures
B) Number and proportion IDU service sites providing each element of the essential package
NSP ST VCT ARVs All elements1
Kazakhstan 129 (NAC) 0 (0%) 659 (NAC) 22 (NAC) 0 (0%)
Kyrgyzstan 51 (NAC) 2 (NAC) 14 (NAC) 6 (NAC) 0 (0%)
Tajikistan 26 (NAC) n/a 140 (NAC) 7 (NAC) 0 (0%)
Turkmenistan NEA (NAC) n/a NEA (NAC) NEA (NAC) 0 (0%)
Uzbekistan 235 (99%) 1 (0.4%) 233 (98%) 2 (0.8%) 0 (0%)
NEA – No estimate available ; NAC – No estimate able to be computed (e.g. denominator missing)
There are a total of 238 sites.
Summary measures
B) Number and proportion IDU service sites providing each element of the essential package
From the 238 sites, 99% (n=235) provide NSP
NSP ST VCT ARVs All elements1
Uzbekistan 235 (99%) 1 (0.4%) 233 (98%) 2 (0.8%) 0 (0%)
Summary measures
B) Number and proportion IDU service sites providing each element of the essential package
From the 238 sites, 98% (n=233) provide VCT
NSP ST VCT ARVs All elements1
Uzbekistan 235 (99%) 1 (0.4%) 233 (98%) 2 (0.8%) 0 (0%)
Summary measures
B) Number and proportion IDU service sites providing each element of the essential package
From the 238 sites, 0.4% (n=1) provides ST
NSP ST VCT ARVs All elements1
Uzbekistan 235 (99%) 1 (0.4%) 233 (98%) 2 (0.8%) 0 (0%)
Summary measures
B) Number and proportion IDU service sites providing each element of the essential package
From the 238 sites, 0.8% (n=2) sites provide ARVs.
NSP ST VCT ARVs All elements1
Uzbekistan 235 (99%) 1 (0.4%) 233 (98%) 2 (0.8%) 0 (0%)
Summary measures
B) Number and proportion IDU service sites providing each element of the essential package
From the 238 sites, no sites provide all elements – nor should they (re. ARVs)
NSP ST VCT ARVs All elements1
Uzbekistan 235 (99%) 1 (0.4%) 233 (98%) 2 (0.8%) 0 (0%)
Summary measures
B) Number and proportion IDU service sites providing each element of the essential package
NSP ST VCT ARVs All elements1
Uzbekistan 235 (99%) 1 (0.4%) 233 (98%) 2 (0.8%) 0 (0%)
But it does raise the qn – what is the right mix?
The right mix?
Only two sites offering ARVs – not enough
NSP ST VCT ARVs All elements1
Uzbekistan 235 (99%) 1 (0.4%) 233 (98%) 2 (0.8%) 0 (0%)
Virtually all “Trust Points” offer NSP and VCT – v.good. But are 235 Trust Points enough for 300,000 IDU? Are they in
the right places? Simply by mapping the sites and collecting these data raises more, and appropriate qns!
Only one site offering ST – definitely not enough
C) Number and proportion of IDU covered by each element of the Essential package
• Basic information – yes?
Kazakhstan NEA (NAC) O (0%) 22 248 (NAC) 205 (0.2%) NEA (NAC)
Kyrgyzstan NEA (NAC) 227 (0.9%) NEA (NAC) NEA (NAC) NEA (NAC)
Tajikistan NEA (NAC) 0 (0%) 4 991 (33%) NEA (NAC) NEA (NAC)
Turkmenistan NEA (NAC) 0 (0%) NEA (NAC) NEA (NAC) NEA (NAC)
Uzbekistan NEA (NAC) 152 (0.2%) 10 994 (14%) 482 (0.6%) NEA (NAC)
Azerbaijan 2 724 (0.9%) 90 (<0.1%) 3 568 (1%) 11 (NAC) NEA (NAC)
NSP ST VCT ARVs All elements
C) Number and proportion of IDU covered by each element of the Essential package
• Basic information – yes?
NSP ST VCT ARVs All elements
Kazakhstan O (0%) 22 248 (NAC) 205 (0.2%)
Kyrgyzstan 227 (0.9%)
Tajikistan 0 (0%) 4 991 (33%)
Turkmenistan 0 (0%) )
Uzbekistan 152 (0.2%) 10 994 (14%) 482 (0.6%)
Azerbaijan 2 724 (0.9%) 90 (<0.1%) 3 568 (1%) 11 (NAC)
C) Number and proportion of IDU covered by each element of the Essential package
• Basic information – yes?
NSP ST VCT ARVs All elements
Kazakhstan O (0%) 205 (0.2%)
Kyrgyzstan 227 (0.9%)
Tajikistan 0 (0%) 4 991 (33%)
Turkmenistan 0 (0%)
Uzbekistan 152 (0.2%) 10 994 (14%) 482 (0.6%)
Azerbaijan 2 724 (0.9%) 90 (<0.1%) 3 568 (1%)
SKIP AHEAD to other basic indicators
• Result is even worse Number (and
proportion) of IDU who received STI
testing and treatment in the past year.
Number (and proportion) of
functional sites with IEC provision on
[census date]
Number (and proportion) of IDUs
who received IEC materials, at least
once, in the last three months
Kazakhstan NEA (NAC) NEA (NAC) NEA (NAC)
Kyrgyzstan NEA (NAC) NEA (NAC) NEA (NAC)
Tajikistan NEA (NAC) NEA (NAC) NEA (NAC)
Turkmenistan NEA (NAC) NEA (NAC) NEA (NAC)
Uzbekistan NEA (NAC) NEA (NAC) NEA (NAC)
Azerbaijan NEA (NAC) NEA (NAC) NEA (NAC)
A quick cautionary note - KISS
So, even basic information is lacking, not collected, or not regionally/nationally collated/aggregated.
A quick cautionary note - KISS
So, even basic information is lacking, not collected, or not regionally, nationally collated/aggregated.
What will it be like for sophisticated, multi-layered indicators requiring multiple sources, various surveys
(e.g.2nd gen)
A quick cautionary note - KISS
NSP
1. Number and proportion of IDU in (at least) weekly contact with NSP
2. Average number of needles and syringes provided per weekly client per contact
3. Total number of needles and syringes distributed in past year
4. Average number of condoms provided per (any) client per contact
5. Total number of condoms distributed to IDU in past year
NSP
1. Number and proportion of IDU in (at least) weekly contact with NSP
Begs the qn – how many IDU are there?
Triangulated convergent validity study
Result
Primary research (e.g. surveys)
Desk review – official, surveillance dataKI interviews
NSP
1. Number and proportion of IDU in (at least) weekly contact with NSP
Why at least weekly?
• We wanted to distinguish between “once only” and “occasional” from “regular” – it was regular that we wanted to
measure
NSP
1. Number and proportion of IDU in (at least) weekly contact with NSP
Why at least weekly?
• What does “regular” mean? Why not just impose “weekly” as a proxy (note: WHO uses “monthly”)
NSP
1. Number and proportion of IDU in (at least) weekly contact with NSP
How do we measure “weekly”
Firstly – need to record frequency of IDU contacts
Secondly– need to know uniqueness of contact (are IDU securing N&S from multiple NSPs).
Therefore – need for a unique identifier
NSP
Unique identifier
• First two letters of mother’s first name• First two letters of father’s first name• Gender (single letter M/F or number)
• Year of birth (last two digits).
NSP
Unique identifier
Paul Williams
• First two letters of mother’s first name = JU• First two letters of father’s first name = KE• Gender (single letter M/F or number) = M
• Year of birth (last two digits) = 54
Unique identifier = JUKEM54
NSP
Unique identifier
Not totally duplicate proof
• First two letters of mother’s first name = June vs Judy• First two letters of father’s first name = Ken vs Keely
• Gender (single letter M/F or number) = both M• Year of birth (last two digits) = both born 1954
Therefore “Unique” identifier = JUKEM54 for more than one individual
NSP
Unique identifier
Not useful in all circumstances
IDU who do not know one or more parents
IDU who do not know year of birth
NSP
2. Average number of needles and syringes provided per weekly client per contact
2. Average number of needles and syringes provided per weekly client per contact
• Is the optimum number of needles and syringes being distributed?
2. Average number of needles and syringes provided per weekly client per contact
• Is an “adequate” number being distributed
2. Average number of needles and syringes provided per weekly client per contact
What does WHO say is an “adequate” number?
NSP
3. Total number of needles and syringes distributed in past year
3. Total number of needles and syringes distributed in past year
• We can compare the average number with total number
3. Total number of needles and syringes distributed in past year
• We can then work out ~regular “take” of total
3. Total number of needles and syringes distributed in past year
• We can then work out ~regular “take” of total
• If matches- v.good; if does not, this indicates problems with the service or measurement etc.
NSP
4. Average number of condoms provided per (any) client per contact
5. Total number of condoms distributed to IDU in past year
4. Average number of condoms provided per (any) client per contact
• This was an attempt to compare IDU to non-IDU, however, in retrospect we should have compared
average (to non-IDU) with average (to IDU)
5. Total number of condoms distributed to IDU in past year
4. Average number of condoms provided per (any) client per contact
5. Total number of condoms distributed to IDU in past year
5. Average number of condoms distributed to IDU in past year
Substitution treatment
1. Number and proportion of opioid IDU receiving daily dosing of a) methadone and b) buprenorphine for at least 6 months in the past year
2. Average dose of a) methadone and b) buprenorphine
3. Number and proportion of prison opioid IDU receiving a) methadone and b) buprenorphine on [census date]
4. Average dose of a) methadone and b) buprenorphine provided to prison opioid IDU
5. Number and proportion of opioid IDU enrolled in any form of non- detox drug treatment for at least 30 days in the past year
Diagnosis and treatment
1. Number and proportion of IDU who received VCT in the past year
2. Number and proportion of all persons who received VCT in past year who are IDU
3. Number and proportion of HIV+ IDU who are receiving ARV on [census date]
4. HIV+ persons in receipt of ARVs who are IDU on [census date] as a proportion of all in receipt of ARVs
5. Number and proportion of IDU who received STI testing and treatment in the past year
The way forward
Advocate for (at least) the Essential Package
Implement (at least) the Essential Package
Measure (at least) the Essential Package
Then pick up on any of the other measures of the Comprehensive Package
Questions?