VIMUKTHI
Alcohol/drug/substance abuse is becoming an increasing menace in our society. Vimukthi is an anti-narcotics campaign launched by the Government of Kerala to highlight the seriousness of the situation and to create awareness among the people, especially the youth. It is a collective effort which aims at eradicating all sorts of narcotic substances from Kerala.It is being implemented with the help of student Police Cadets, Vimukthi Anti Drug Clubs of Schools and Colleges, National Service Scheme , Kudumbasree, Residents Association, State Library Council, and anti alcoholic organization, different student, youth and women’s organizations and Vimukthi Committees formed in Ward, Panchayat and Block levels of Local Bodies.Addiction free Kerala is the aim of this campaign drive. State wide campaigns to make students, youth and general public aware of the evils of drug addiction and alcoholism is being conducted as part of the mission under Excise Department. A governing body with the
Chief Minister as Chairman and Minister for Excise as Vice Chairman is constituted in the apex level. Additional Chief Secretary, Taxes is the Convener of the mission. Ministers of Health, Local Self Government, Finance, Education, Trade, SC/ST and Fisheries are members of the body. The Chief Secretary, President of Sports Council, Advocate General, President of Kerala Panchayat Association and representatives from the fields of sports , arts, culture and literature are also members. Committees are formed in wards at the District, Local Self Government levels. Drug Free State is the motto of the mission. VDC Provides services of Psychiatrist, Clinical Psychologist and Sociologist. Also provides inpatient de addiction treatment for ten patients at a time.
Integrated Counselling and Testing Centre (ICTC)
The Basic Services Division of Kerala State AIDS Control Society provides HIV Counseling and Testing Services (HCTS) for HIV infection, the critical first step in detecting and linking people with HIV to access treatment cascade and care. It also provides an important opportunity to reinforce HIV prevention. The national programme is offering these services since 1997 with the goal to identify as many people living with HIV, as early as possible (after acquiring the HIV infection), and linking them appropriately and in a timely manner to prevention, care and treatment services. The introduction of ART services for people living with HIV/AIDS in 2004, gave a major boost to counseling and testing services in India.The Basic Services Division through Integrated Counseling and Testing Centres (ICTCs) provide HIV counseling & testing services, Prevention of Parent to Child Transmission of HIV (PPTCT) services and HIV-TB cross referrals. These services have linkages with TI NGOs/CBOs and outward linkages with ART centres, outreach services, peer support services, OI management and home based care. NACP-IV envisages integration and scale-up of service delivery to sub-district and community levels through existing infrastructure in the public and private sectors.In the financial year 2019-20, a total of 759 HCTS facilities were functional in the state, providing HIV counselling & testing services. In accordance with the global vision to end AIDS as public health threat by 2030, India has moved ahead towards achieving the global 90:90:90 target by 2020, wherein 90% of people living with HIV would know their HIV status, 90% of people who know their HIV status will receive treatment and 90% of people on treatment would have suppressed viral load to minimize HIV transmission.Scaling up of HIV Counselling & Testing Services (HCTS) is a crucial step towards achieving the first 90, wherein, it is desired that 90% of the estimated PLHIV are aware of their HIV status. Achieving this is vital for the success of the subsequent 90:90 related to anti-retroviral treatment and viral suppression.
Opioid Substitution Therapy (OST)
It is estimated that there are 177000 IDUs in India. The distribution of Injecting Drug Use (IDU) population is not uniform throughout the country.
As of 2014, there are some states that have high number of Injecting Drug Users (IDUs) including, Manipur, Nagaland, Punjab, Mizoram and Delhi.
IDU is an important factor in the transmission dynamics of HIV epidemic in India. HIV in India is a concentrated epidemic – concentrated in certain
geographical areas and among certain population groups. These population groups, designated as High Risk Groups (HRGs), have much higher prevalence
of HIV as compared to the general population. As per the latest HIV sentinel surveillance report, HIV prevalence among IDUs is 7.2% nationally, which
is one of the highest among any population group. However, some states have much higher HIV rates among IDUs; for e.g. HIV prevalence among IDUs
is 21% in Punjab, 18% in Delhi and around 12% in Manipur and Mizoram.Thus, there is considerable variability among IDUs in terms of their numbers, their choice of drugs for
injecting, their socio-demographic characteristics, and HIV prevalence among the group.
A. NATIONAL STRATEGY FOR HIV PREVENTION AMONG IDU POPULATION
Globally, the “harm reduction” strategy is employed to manage HIV prevention among IDUs. Harm
reduction strategy is based on the premises that it is as important to focus on addressing harms
associated with drug use as it is to help them give it up. The strategy offers an effective alternative
approach for continuous engagement and HIV prevention among drug users, especially those who
are unable or unwilling to give up drug use through other abstinence-oriented approaches. Priority is
accorded to immediate, easily preventable harms of public health importance. HIV prevention becomes
an important focus of harm reduction. A number of interventions have been found to be useful and
effective for HIV prevention among IDUs. WHO, UNAIDS and UNODC, together, have proposed nine
interventions for HIV prevention, care and treatment of IDUs which, when implemented together, are called
the “comprehensive package of interventions” for HIV prevention among IDUs. The core interventions
among these include – Needle Syringe Programme (NSP), Opioid Substitution Therapy (OST), and AntiRetroviral Treatment (ART).
In India, the harm reduction strategy is endorsed in the National AIDS Prevention and Control Policy
(NAPCP), 2002. Department of AIDS Control (DAC) is the nodal agency responsible for HIV prevention,
care and treatment in India. DAC follows a ‘targeted intervention (TI)’ approach for HIV prevention among
all HRGs, including IDUs. The targeted intervention approach entails providing interventions specifically
aimed at HRGs through outreach and peer-based delivery. In the ‘outreach’ model, services are
delivered at places where the HRGs are most likely to be found, using their own peers as primary agents
of service delivery (peer-based service delivery). The TI projects are implemented by Non-Governmental
Organisations (NGOs) who are able to reach out to HRGs much more efficiently as compared to
the traditional service delivery systems. For HIV prevention among IDUs, the TI-based services
include – NSP, condom distribution, abscess prevention and management, general medical care,
STI prevention and treatment, and behaviour change communication. Additionally, testing for HIV, ART, TB
diagnosis and treatment, as well as drug treatment services are provided through referral linkages to the
concerned service provider/s. As in 2014, there are more than 280 core IDU
TIs throughout the country, reaching out to about 152000 IDUs, which is more than 80% of the IDU
population in the country. Thus, there is a saturation of the coverage of IDUs with HIV prevention services
in India. Programmatic data also shows that there has been a significant increase in commodity
distribution, number of needle/syringes distributed per IDU, referrals for HIV testing, etc.
COMPREHENSIVE PACKAGE OF INTERVENTIONS
- Needle syringe programmes
- Opioid Substitution Therapy
- Anti-retroviral therapy
- Counselling and testing for HIV
- Prevention and treatment for Sexually Transmitted Infections (STIs)
- Condom programme for Injecting Drug Users and their partners
- Targeted Information, Education and Communication
- Prevention, diagnosis and treatment of Tuberculosis
- Prevention, diagnosis and treatment of Viral Hepatitis
B. OPIOID SUBSTITUTION THERAPY UNDER NATIONAL AIDS CONTROL PROGRAMME
OST as a HIV prevention strategy among IDUs was formally integrated in National AIDS Control
Programme (NACP) in 2007, during its third phase. Before formal integration, OST for HIV
prevention among IDUs was being implemented in India by some NGOs. After a formal approval
for OST implementation, besides putting in place mechanisms for financial support to the NGOs
implementing TI projects, a number of documents for standardisation and quality assurance have been
developed by DAC, including practice guidelines for buprenorphine, standard operating procedures and
quality assurance manual. The NGO OST centres were also accredited through an independent
accreditation agency, following which they started receiving support through DAC. In this NGO-based
model of OST, the OST centres located within the Drop-in-Centre (DIC) of an IDU TI are managed by
the staff implementing the IDU TI. A part-time doctor, a full time nurse, a counsellor/ANM, programme
manager and outreach workers are part of the team delivering OST services.
To further expand the OST programme, since 2010, Government hospitals have also been roped in for
providing OST services through a collaborative public health model. In this model, the OST centre
is located within the government hospital and is manned by a full-time staff comprising of a doctor,
a nurse, a counsellor and a data manager. The staff of the OST centre works under the direct supervision
of a designated ‘nodal officer’, who is a full-time employee of the hospital. The OST centre is linked
with an IDU TI located in the vicinity of the hospital for initial referral of IDU clients to the centre, as well
as field-based follow-up and advocacy. Currently, there are about 150 OST centres in the country
supported by DAC, operating through either the NGO or the collaborative public health model, catering to
about 15000 IDUs. There is a plan to establish about 350 OST centres and increase the OST coverage to
35000 – 40000 IDUs during NACP IV.
| OST Medical Officer: |
Dr. Joseph Chacko |