Bulletin of the World Health Organization

Delivery models of opioid agonist maintenance treatment in South Asia: a good beginning

Ravindra Rao, Alok Agrawal, Kunal Kishore & Atul Ambekar

Volume 91, Number 2, February 2013, 150-153

Table 1. Comparison of opioid agonist maintenance treatment (OAMT) delivery models in four countries of South Asia

Model – salient features Bangladesh India Maldives Nepal
Estimated no. of people injecting opioids 20 000–40 000 106 518–223 121 690–896 16 100–28 000
Drug used for OAMT Methadone Buprenorphine, methadone Methadone Methadone
Approximate no. of OAMT clients 163 5800 80 400
Beneficiaries People who inject opioids People who inject opioids People with opioid dependence People who inject opioids
OAMT coverage of people injecting opioids (%) 0.4–0.8 2.6–5.4 8.9–11.6 1.4–2.5
No. of centres 1 62 buprenorphine centres; 5 methadone centres 1 3
Location of centre(s) GO-run hospital NGO model: NGO-run targeted intervention sites Government agency Psychiatry departments in government hospitals
GO-NGO model: government hospitals
Medical services OAMT clinic OAMT clinic OAMT clinic OAMT clinic
Psychosocial services OAMT clinic NGO model: OAMT clinic OAMT clinic and NGOs working with people who inject opioids NGO-run SSUs co-located with OAMT clinic
GO-NGO model: OAMT clinic
Outreach and follow-up OAMT clinic NGO model: OAMT clinic NGOs working with people with opioid dependency NGO-run SSUs co-located with OAMT clinic
GO-NGO model: NGO targeted intervention for people who inject opioids
Staff One programme manager, full-time physician, two nurses and one counsellor; team of outreach workers NGO model: one full-time nurse; others (programme manager, part-time physician, counsellor, outreach workers) shared with the NSP programme. One full-time physician, one part-time psychiatrist, two nurses, team of 3 to 4 counsellors - MMT clinic: one full time physician, nurse, counsellor
GO-NGO model: one full time physician, nurse, counsellor, data manager; outreach workers are part of the NSP targeted intervention - SSU: programme manager, outreach workers, peer educators, coordinators, etc.
Dispensing modality Directly observed Directly observed Directly observed Directly observed
Is take-home dose provided? No No No No
Is urine screening mandatory? No No Random and regular urine screening conducted No
Is attendance to counselling services mandatory? No No Strong emphasis on counselling services No

GO, government; MMT, methadone maintenance treatment; NGO, nongovernmental organization; NSP, needle and syringe programme; SSU, social support unit.