Opioid substitution therapy in manipur and nagaland, north-east india: operational research in action

Abstract

BackgroundThere is good evidence for the effectiveness of opioid substitution therapy (OST) for injecting drug users (IDUs) in middle and high-income countries but little evidence regarding the provision of OST by non-government organisations (NGOs) in resource-poor settings. This paper reports on outcomes of an NGO-based OST program providing sub-lingual buprenorphine to opiate dependent IDUs in two north-east Indian states (Manipur and Nagaland), a region where conflict, under-development and injecting of heroin and Spasmoproxyvon (SP) are ongoing problems. The objectives of the study were: 1) to calculate OST treatment retention, 2) to assess the impact on HIV risk behaviours and quality of life, and 3) to identify client characteristics associated with cessation of treatment due to relapse.MethodsThis study involves analysis of data that were routinely and prospectively collected from all clients enrolled in an OST program in Manipur and Nagaland between May 2006 and December 2007 (n = 2569, 1853 in Manipur and 716 in Nagaland) using standardised questionnaires, and is best classified as operational research. The data were recorded at intake into the program, after three months, and at cessation. Outcome measures included HIV risk behaviours and quality of life indicators. Predictors of relapse were modelled using binary logistic regression.ResultsOf all clients enrolled in OST during the month of May 2006 (n = 713), 72.8% remained on treatment after three months, and 63.3% after six months. Statistically significant (p = 0.05) improvements were observed in relation to needle sharing, unsafe sex, incidents of detention, and a range of quality of life measures. Greater spending on drugs at intake (OR 1.20), frequently missing doses (OR 8.82), and having heroin rather than SP as the most problematic drug (OR 1.95) were factors that increased the likelihood of relapse, and longer duration in treatment (OR 0.76) and regular family involvement in treatment (OR 0.20) reduced the likelihood of relapse.ConclusionThe findings from this operational research indicate that the provision of OST by NGOs in the severely constrained context of Manipur and Nagaland achieved outcomes that are internationally comparable, and highlights strategies for strengthening similar programs in this and other resource-poor settings.

Scale-up of a comprehensive harm reduction programme for people injecting opioids: lessons from north-eastern India

“…15 The retention rate of clients in the opioid substitution treatment programme after 6 months is 63%. 14,16 Between 2009 and 2011, the percentage of registered programme participants who had been injecting opioids for less than one year increased from 4% (146) to 21.5% (1071), and the fraction of females registered at the programme increased from 2.7% (119) to 7% (340). Between 2010 and 2012, the fraction of females injecting opioids who were contacted monthly increased from 69% (104) to 100% (150) and monthly tests for HIV increased from 3% (5) to 8% (12) Safe injecting behaviour, already frequent among people injecting opioids (i.e.…”

Opioid substitution therapy in resource-poor settings

“…Following two successful pilots in 1999-2002 12 and 2006-07, 11 the National AIDS Control Organization has included opioid substitution therapy in its third five-year plan, proposing to scale-up the programme to reach 40 000 injecting drug users by 2011. 13 However, coverage remains inadequate at this time and challenges to the scale-up include: current unavailability of methadone (but not of buprenorphine, a more costly alternative); ineffective health services in some areas, necessitating government accreditation and monitoring of many existing opioid substitution therapy programmes run by nongovernmental organizations; and residual scepticism about its value in India.…”

Prevention of HIV/AIDS with opioid substitution therapy: An exploratory study among injecting drug users in a tertiary health-care center of Kolkata

“…Study conducted by Armstrong et al revealed that 47.3% and 44.8% were single among the IDUs in Manipur and Nagaland, respectively. [11] Separated or divorced IDUs were found to be 3.6% and 3.2% in the above mentioned two northeastern states, respectively. [11] In our study, 36% percent IDUs were illiterate whereas only 8.8% of the study participants studied up to secondary level and above (Table 1).…”

“…[11] Separated or divorced IDUs were found to be 3.6% and 3.2% in the above mentioned two northeastern states, respectively. [11] In our study, 36% percent IDUs were illiterate whereas only 8.8% of the study participants studied up to secondary level and above (Table 1). Razzaghi et al in his study in Tehran showed that out of the 154 IDUs who had participated in the study, 18.7% were either illiterate or were barely able to read and write while only 10.7% had graduated from high school or had higher education.…”

“…A study conducted by Armstrong et al showed that most clients in Manipur reported using heroin (90.7%) whilst in Nagaland approximately equal proportions reported using heroin and spasmoproxyvon (63.1% and 68.3%, respectively). [11] In states such as Karnataka, Andhra Pradesh, and Chhattisgarh. Pentazocine is the commonly injected opioid.…”