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.