INTRODUCTION TO OUTREACH

A systematic approach of delivering HIV prevention services to people injecting drugs in their environments. WHAT DOES OUTREACH MEAN?

WHY SHOULD WE DO OUTREACH? Conventional service delivery approaches have not proved effective for IDUs Majority of IDUs are not ready to accept HIV prevention as their responsibility Outreach service seems more acceptable to IDUs and in addressing their needs HIV prevention requires rapid & wide scale coverage within shortest possible time Outreach often links IDUs with other services

WHAT CAN OUTREACH ACHIEVE? 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

WHAT ALL DOES OUTREACH INVOLVE? Effective & detailed outreach planning Finding & contacting IDUs at places where they live, work, buy, sell and use drugs Building rapport with IDUs so as to ensure their full participation Providing IDUs with information and materials to prevent HIV and other BBV Linking them with DIC, ICTC, ART, STI clinic, DOTS Centre, OST services, general health services, detoxification and rehabilitation centres and other welfare services Providing services- NSEP/condom on a regular basis as and when the client needs it

PRINCIPLES OF OUTREACH Information collected in the process of outreach (planning & conducting) should remain confidential Outreach should be consistent & adequate Outreach should be flexible in order to meet the needs of IDUs Outreach done in isolation is less effective Outreach should ensure active involvement of IDUs Outreach efforts must address both injecting as well as sexual risks of IDUs & partners

CONDUCTING OUTREACH

Outreach (planning and conducting) is the most important activity of a TI programme Outreach requires careful planning and coordination among staff of the TI The quality of outreach determines outcome of the programme Constant monitoring and re-planning (of outreach) is required to reflect & address the changing patterns & needs of IDU Introduction

STEPS IN CONDUCTING OUTREACH Step 1: Building rapport with the IDU and general community Step 2: Delivering services in the field; referrals to DIC and other services Step 3: Creating enabling environment for effective delivery of and access to services Step 4: Documenting and analysing collected data for re-planning/re- strategising outreach

CONDUCTING OUTREACH - STEP 1 Building rapport/trust with the IDU and general community It is the first step towards conducting street/community outreach. This is a time consuming task and an ongoing process. A good rapport will enable the outreach team to deliver services effectively without the interference of the general community

CONDUCTING OUTREACH - STEP 2 Delivery of Services Ensure outreach plan is ready Before initiating outreach services, the outreach team should have a detailed outreach plan ready. On the basis of the detailed plan, timing of services, area of delivery, delegation of PE etc. should be decided Every effort should be made to cover each and every IDU with services IDU should be tracked periodically to ensure consistent use of safe N/S and condoms through individual tracking mechanism

STEP 2 CONTD. The following are provided during outreach: –Risk reduction sessions/messages (through Interpersonal Communication, IPC) –Materials (including needle/syringe and condom) –Services including BCC, return of used N/S, referrals, abscess management (if simple), Overdose management/prevention

CONDUCTING OUTREACH - STEP 3 Creating Enabling Environment A safe and supportive environment is required for effective delivery of services and assisting the IDU to access available services without fear or stigma An analysis of the barriers to conducting outreach should be conducted with peers and community An enabling environment can be created by carrying out community advocacy

CONDUCTING OUTREACH - STEP 4 Documentation and Analysis Outreach conducted (data) should be documented using tools provided by PM A weekly analysis of the data should be done by ORW with PE and IDU The analysis should focus on: 1.Whether all IDUs are being covered 2.Whether all IDUs are being covered regularly

STEP 4 CONTD. 3.What are the barriers to accessing services? 4.How to strengthen service uptake? Outcome of the analysis should be shared with relevant staff In case the outreach team is unable to address gaps, help should be sought from the PM and other senior staff Joint periodic reviews should be conducted to avoid duplication of coverage

MANAGING PEER EDUCATORS

MANAGING PEs ORW need to manage their PE through: 1. Understanding common problems with PE 2. Knowing how to support PE 3. Building capacity of PE 4. Mentoring PE 5. Evaluating the work of PE through supervision and monitoring

COMMON PROBLEMS WITH PEs Difficulty keeping own drug use under control Conflict between being a professional health care worker and maintaining peer status Occupational stress associated with demanding nature of peers Lack of supervision & support can affect self-discipline Lack of professional status, acknowledgement of work undertaken and measurable outcomes prove frustrating

HOW TO SUPPORT PEs? Identify areas of technical support and training for each PE and forward this information to the Project Coordinator/ Manager The ORW should make a point to praise their PE for a job well done

BUILDING CAPACITY OF PEs Capacity of PE can be built through both in-house formal training and on- the-job training The capacity building should be ongoing Technical skills related to health issues (HIV/AIDS/STI/Hep B & Hep C) and harm reduction should be developed in PE Life skills like negotiation, communication and leadership should be developed in PE Training should be interesting & simple

MENTORING PEs (dos and don’ts) Be yourself & allow the PE to be themselves Be a good listener Don't attempt to handle situations with PE for which you are not qualified Clearly outline & discuss PE responsibility Be available

CONTD. Monitor PE’s progress Follow up on commitments made Be realistic with your PE and encourage them to explore options when appropriate Do not betray confidential information Goals and accountability should be encouraged throughout the mentoring process

EVALUATING THE WORK OF PEs Assist PE to understand objectives Develop a weekly work plan with PE; include targets and follow- up plans Follow up on weekly achievements Analyse results of PE’s work with PE keeping objectives/goal in mind Meet with PE peers to gauge extent of information and services provided Discuss your findings with PE