Issue Clinics in fixed locations have limited effectiveness in HIV/STI prevention programs among injecting drug users (IDUs) in North-East India. Mountainous terrain and poor roads make physical accessibility difficult, and designated IDU clinics are often stigmatised by the general community, reducing acceptability among IDUs.
Setting Nagaland state in Northeast India has a porous border with Myanmar and is characterised by difficult terrain, poor infrastructure, and a conservative religious climate generally intolerant of IDUs. HIV and STI prevalence rates among IDUs are among the highest in India. HIV prevalence is 1.8% (2008), while syphilis prevalence is as high as 17% (2009) and chlamydia as high as 13% (2009) in some districts.
Project Project ORCHID, funded by Avahan India, has been implementing HIV/STI targeted interventions among IDUs in Nagaland since 2004. In response to the high prevalence of STIs and the clinic access challenges facing IDUs, an outreach clinic service known as the Confined Outreach Clinic (COC) was developed. The COCs are conducted by trained clinical staff and outreach teams in locations convenient to the IDUs. Timing and locations for the clinics are chosen by the IDU community in consultation with the outreach teams to ensure maximum acceptability and attendance. Clinical services follow standardised national guidelines. They provide STI treatment as well as HIV/STI prevention and referral services. To maximise acceptability, some general medical services are also provided.
Outcomes Clinic visits more than doubled after introduction of this model, from 1734 (July–December 2009) to 4347 (January–June 2010), while the number of individuals accessing the clinic increased by 68%. The COC model therefore not only increased population coverage but also the number of repeat clinic visits within the reporting period. COCs are a low cost and highly acceptable model of service delivery for IDUs, effective in improving poor service uptake.
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