Understanding, Planning and Managing Outreach 1

“Outreach is a systematic approach to delivering HIV prevention services to people injecting drugs in their environments” 2

Why Outreach? Injecting drug use is illegal and not socially approved IDUs are stigmatised by self, service providers and society IDUs are preoccupied and not able to focus on other needs IDUs remain hidden and do not seek services Conventional service delivery approaches have not been effective Majority of IDUs not ready to accept responsibility for their own HIV prevention Outreach service more acceptable to IDUs in addressing their needs HIV prevention requires rapid and wide-scale coverage within shortest possible time Outreach often links IDUs with other services-TB,STI, ICTC, ART 3

Objectives of Outreach Overall Objective: To prevent transmission of HIV & other blood- borne viruses among IDUs Specific Objectives: 1. To ensure IDUs have easy access to and utilise available services 2. To ensure significant reduction in needle sharing and unsafe sexual contact 3. To prevent drug use related harms 4. To mobilise the IDU community 4

Services Provided Through Outreach Education, advice, information on Risks of HIV, HBV/HCV, STIs and means of reducing risks Safer injecting & safer sex practices Prevention and management of overdose & abscess Services available for  STI diagnosis and treatment  HIV testing  ART  TB 5 Contd…

Services Provided Through Outreach Distribute the following commodities regularly, as per need of the IDUs and their regular sex partners: New needles and syringes Abscess prevention materials such as alcohol swabs, distilled water etc. Condoms – free as well as socially marketed IEC materials, as and when required Collect used/old needles and syringes Provide referral services to appropriate healthcare and other agencies 6

PLANNING CONDUCTING The Team 7 MONITORING MANAGING PM ORW PE ORW PE IDU

Outreach Involves PlanningConductingMonitoring 8

Objectives of Planning Identify the number of IDUs at each site Estimate required risk reduction materials (like N/S and condoms) for adequate and uninterrupted supply Facilitate effective individual tracking vis- à-vis service access and behaviour modification Collect information for effective action plans Enhance participation of IDUs in program planning Identify and monitor problem areas for improved service 9

Key Questions to Consider How many IDUs are there in the target area? Can we reach all? How many regular injectors are there in the IDUs? Can we meet them according to their accessibility rather than on the basis of their risk/vulnerability? How many N/S or condoms do we need in a month to cover risk occasions? Does the outreach timing suit the IDUs? Can we track each individual? 10

Outreach Planning 1.Social mapping 2. Spot analysis 3. Contact mapping 4. Risk & Vulnerability assessment 5. Outreach plan 11

A Social Map 12

1. Social Map A social map is a rough diagram of the intervention area Shows overview of the sites/areas where IDUs gather (hotspots) and can be accessed Shows service points such as hospital/NGO/clinics/referral health care, condom supply, ICTC, ART, STI, TB etc. Purpose – establish a dynamic understanding of IDUs for complete coverage through Outreach in the project site Map to be drawn by IDUs, PEs led by ORW 13

Developing a Social Map Social mapping can be conducted as either a field or DIC activity by PE and ORW involving (IDU). The PM can act as facilitator in the process Social map should be updated regularly Inclusion of IDUs will ensure their views and wisdom are represented since they are better informed than outsiders 14

2. Spot Analysis Provides number of IDUs in a particular spot according to their: Time of availability Age Type of drugs injected Frequency of injecting  daily injectors (at least one injecting episode per day)  non-daily injectors (less than one injecting episode per day) To be conducted by PEs supervised by ORWs 15 Contd…

2. Spot Analysis 16 District/TI areaLocationSpotDate of analysis StreetHome Age < < Daily Non- daily Daily Non- daily Daily Non- daily Daily Non- daily Daily Non- daily Daily Non- daily Time

3. Contact Mapping Questions: – How many contacts in each spot? – In which spot are the contacts limited? – What are the reasons for limited contacts? – What should be done in locations where contacts are limited? – Is there a duplication of names in the contact list? Helps in planning coverage and reaching services to individual IDUs Conducted by PE and facilitated by ORWs 17 Contd…

3. Contact Mapping 18

4. Risk/Vulnerability Assessment The ORW / PE should collect the following information from each IDU The risk/ vulnerability parameters should, at the minimum, include: 1. Types of drug injected 2. Frequency of injection 3. Sharing of N/S or other injecting equipment 4. Sexual behaviour: frequency of sexual intercourse, protected /unprotected sex 5. Sensitivity about disclosure (to family/ others about their drug use/sex work) 19

Outreach Plan Outreach plan is developed using spot analysis, social mapping, contact mapping and risk and vulnerability analysis Plans a weekly target for outreach to the IDUs of each area (hotspot) Weekly plan for each PE can be different as per the variation in needs, spots, risks and vulnerabilities. Should vary from week to week depending on the service uptake/ outreach patterns Should tie into other activities designed to increase IDU engagement or service utilization Is led by the ORW and monitored by PM 20

Conducting Outreach Step 1: Building rapport with the IDU and the general community Step 2: Delivering services in the field; referrals to DIC and other services Step 3: Creating enabling environment Step 4: Documentation and Analyses 21

Services Provided in Outreach Needle Syringe Exchange Program (NSEP) Behaviour Change Communication (BCC) Condom Promotion Referrals Creating enabling environment 22

Monitoring Field level: ORW with the PEs TI level: PM with ORWs and PEs 23

What to Monitor Coverage as per target and plan Reaching out to identified population as per plan N/S supply as per calculated demands Other provisions (cotton swab, distilled water- as planned by TI) for safer injecting Condom supply as per calculated demand Referral to DIC Follow-up on referrals BCC at the field level Documentation 24

Monitoring Through Field Visits PM should visit the hotspots two to three times a week, some may be surprise visits During the visits the PM should be meeting: Some IDUs Some stakeholders (local- tea, paan sellers, pharmaceutical shop owners/staff, community leaders/key influencers, police etc.) The PEs and ORWs working in the hotspot 25

Monitoring Through Document Review The following records/documents should be reviewed every fortnight: Outreach plan including spot analysis N/S stock register DIC registration records DIC service utilisation registers PE weekly planning & activity sheet (Form B1 for IDUs) PE-wise individual HRG sheet compiled for IDU intervention (by ORW) (Form C) Monthly CMIS report 26

Monthly Review Meeting The PM should also conduct review meetings at the DIC with the ORWs at least once in a fortnight During the review meeting the PM should base the discussion on his/her findings from: Field visit Record/documentation review ORW-PE field level 27

Roles and Responsibilities of PM Ensure: Outreach team conducts outreach planning Outreach team meets on a weekly basis updating on the previous week and planning for the coming one Enough commodities are available at the DIC/NGO office for outreach activities A backup plan for outreach staff taking leave/being absent Vacancies due to staff drop-outs are filled up Set up a routine monitoring mechanism for supervision Monitor the outreach activities Build the capacity of the outreach team 28

Thank You !! 29