Use of DatStat software for data collection, monitoring and evaluation of naloxone peer distribution programs to respond to opiate overdoses among people living with HIV (PLWH) and injection drug users (IDUs) in Central Asia Sholpan Primbetova, Nabila El-Bassel, Louisa Gilbert, Assel Terlikbayeva, Tim Hunt, Anne Malin Columbia University Global Health Research Center of Central Asia Almaty, Kazakhstan u Materials and Methods Regional Capacity Building  Established local partnerships with 6 sites in three countries  Conducted needs assessment on overdose and naloxone use by ambulances and NGOs  Conducted training for partners on naloxone peer distribution and client outreach  Developed and implemented a system for electronic data collection, monitoring and evaluation of overdose incidents, and use of naloxone for partners using DatStat  Trained partners to collect data using hand held devices which connect to a secure server and allow for remote data collection  Conducted stakeholders regional conference to discuss findings from pilot naloxone distribution project, identify barriers to distribution, and make policy and program recommendations Table 1. Outcomes of overdose reversal and fatality in CA Introduction Death from opiate overdose is one of the leading causes of mortality among PLWH and IDUs in Central Asia. However, none of these countries have official data on opiate overdose cases or monitor the use of naloxone. Project ADVANCE (Advocacy and Assessment of Naloxone in Central Asia) is designed to develop tools for evidence-based advocacy and to strengthen capacity of local NGOs through educating them to use an electronic information system to track the response to HIV and overdose. Acknowledgments We thank Open Society Foundations for providing funding opportunities for the ADVANCE study in Kazakhstan, Kyrgyzstan and Tajikistan. We thank NIDA for providing funding for the Renaissance study where peer distribution of naloxone was introduced in Kazakhstan. We highly appreciate the collaboration on this project with NGOs “Volontyor,” “Apeyron,” and Open Society Foundations Assistance Foundation (Tajikistan), NGOs “Attika” and “Parents Against Drugs” and Soros Foundation (Kyrgyzstan) and Renaissance team, NGO “Doverie” and Almaty emergency station (Kazakhstan). Presented at AIDS 2012 – Washington, D.C., USA Map of Central Asia identifying the project’s geography: Almaty in Kazakhstan, Bishkek and Osh in Kyrgyzstan, Dushanbe and Khorog in Tajikistan Outcome of Overdose Incident when Naloxone was Administered KazakhstanKyrgyzstanTajikistan CountPctCountPctCountPct Successful reversal: The person recovered without medical aid 4987,5%2195,5%2826,7% The person recovered after rendering him/her medical aid 610,7%00%7470,5% The person was taken to the hospital 00%0 21,9% Fatal incidence: The person died immediately11,8%14,5%10,9% The person died in the hospital00%0 0 Conclusion and Recommendations  The findings suggest region-wide peer distribution of naloxone is safe and effective and should be scaled up  Several barriers impeded naloxone distribution in different countries that need to be addressed in the future, including fear of arrest for carrying naloxone, need to register as a drug user to receive naloxone and interruptions in naloxone supply  Cross-cutting country-wide and regional partnerships with government and NGO partners are essential for addressing barriers to scaling up naloxone distribution  Surveillance of overdose morbidity and mortality in all three countries is woefully inadequate. Electronic data management system on overdose employed by this project holds promise as a tool to improve surveillance  Data on overdose incidence and use of naloxone are needed to advocate for policies and programs that will widen access to naloxone among PLWHA and PWID Literature Cited Атаянц, Ж., Латыпов, А., Очерет, Д., (2011). Передозировка: Обзор ситуации и ответные меры в 12 странах Восточной Европы и Центральной Азии. Вильнюс: Евразийская сеть снижения вреда. Bartlett, N., Xin, D., Zhang, H., and Huang, B. (2011). A qualitative evaluation of a peer-implemented overdose response pilot project in Gejiu, China. The International journal on drug policy, 22(4), Bennett, A. S., Bell, A., Tomedi, L., Hulsey, E. G., and Kral, A. H. (2011). Characteristics of an Overdose Prevention, Response, and Naloxone Distribution Program in Pittsburgh and Allegheny County, Pennsylvania. Journal of urban health bulletin of the New York Academy of Medicine. Retrieved from ttp:// Coffin, P., Overdose: A Major Cause of Preventable Death in Central and Eastern Europe in Central Asia Recommendations and overview of the situation in Latvia, Kyrgyzstan, Romania, Russia and Tajikistan, Eurasian Harm Reduction Network (EHRN), Vilnius, August El-Bassel, N., et al. (2012). Overdose Prevention among IDUs in Kazakhstan: The Role of Naloxone in Opioid Overdose Fatality Prevention. Paper presented at the Federal Drug Administration Hearing: Role of Naloxone in Opioid Fatality Prevention, Silver Spring, Maryland; Gaston, R. L., Best, D., Manning, V., and Day, E. (2009). Can we prevent drug related deaths by training opioid users to recognize and manage overdoses? Harm Reduction Journal, 6(1), 26. BioMed Central. North Carolina Medical Board (2007). Project Lazarus: Policy Briefing Document. Wilkes County, North Carolina. Primbetova, S., et al. (2012). Making Naloxone available for those who need it: from needs assessment to advocacy. Unpublished. Columbia University Global Health Research Center of Central Asia, Almaty, Kazakhstan. Seal, K. H., Thawley, R., Gee, L., Bamberger, J., Kral, A. H., Ciccarone, D., Downing, M., et al. (2005). Naloxone distribution and cardiopulmonary resuscitation training for injection drug users to prevent heroin overdose death: a pilot intervention study. Journal of urban health bulletin of the New York Academy of Medicine, 82(2), Tobin, K. E., Sherman, S. G., Beilenson, P., Welsh, C., & Latkin, C. A. (2009). Evaluation of the Staying Alive program- me: training injection drug users to properly administer naloxone and save lives. The International journal on drug policy, 20(2), Retrieved from Results Final 2011 data collected from 212 IDUs and 5 NGOs:  188 (94.7%) cases of naloxone administration were analyzed and demonstrated effectiveness in reversing overdose experienced by IDUs  24 (13%) did not use naloxone after receiving it (1 case in Tajikistan, 7 cases in Kazakhstan, and 16 cases in Kyrgyzstan)  98 (52%) recovered without additional medical aid  80 cases (42.6%) recovered after ambulance was called  2 cases (1.1%) were taken to the hospital by ambulance and survived  5 cases of missing data  3 cases (1.6%) in which people died due to late injection of naloxone or a heavy mix of alcohol