Additional Professor, NDDTC, AIIMS, New Delhi Member: Strategic Advisory Group, IDU and HIV, United Nations Member: Technical Resource Group, IDU - HIV, NACO, Govt. of India Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
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Additional Professor, NDDTC, AIIMS, New Delhi
Member: Strategic Advisory Group, IDU and HIV, United Nations
Member: Technical Resource Group, IDU - HIV, NACO, Govt. of India
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
What’s so special about OST?0 A Medical intervention 0 Involves providing a medication which
0 Has abuse liability of its own 0 Is controlled under the regulations
0 More technically intensive than other interventions 0 More resource intensive than other interventions
……Adequate capacities of service providers and adequate standards of services are critical
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Case study0 NACO OST Programme for IDUs (as HIV prevention)
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
NACO OST Programme: NGO ‘TI’ model
Govt. HOSPITAL
NGO TIDelivery of various harm reduction services: including NSEP and OST
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
NACO OST Programme: GO-NGO model
Govt. HOSPITALwith OST
NGO TIDelivery of various harm reduction services: including NSEP
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Case study0 NACO OST Programme for IDUs (as HIV prevention)0 Two models
0 NGO TI model 0 GO-NGO collaborative model
0 Human resources: Doctor, Nurse, Counselor, managerial staff
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
NACO OST Programme: Mechanisms for building capacities and ensuring quality
1. Training
2. Quality Assurance / Mentoring
3. Accreditation
Capacity Building
Evaluation Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
1. Training
2. Quality Assurance / Mentoring
3. Accreditation
Capacity Building
Evaluation
NACO OST Programme: Mechanisms for building capacities and ensuring quality
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Induction Training on OST0 A five day training programme 0 Conducted soon after recruitment of staff 0 Conducted for a mixed group of staff (nodal officers,
doctors, nurses, counselors, data managers, programme managers and outreach workers)
0 Class-room type training 0 Highly interactive and participatory 0 Exposure visit – an essential component
0 BASED UPON A MANUAL 0 Outcome:
0 Trained staff who begin service delivery after receiving a certificate
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Induction Training on OST0 A five day training programme 0 Conducted soon after recruitment of staff 0 Conducted for a mixed group of staff (nodal officers,
doctors, nurses, counselors, data managers, programme managers and outreach workers)
0 Class-room type training 0 Highly interactive and participatory 0 Exposure visit – an essential component
0 BASED UPON A MANUAL 0 Outcome:
0 Trained staff who begin service delivery after receiving a certificate
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Organization of the manual
Rajat Ray, Anju Dhawan, Atul Ambekar (2011), Implementing OST : A Training manual for service providers, NACO, Government of India, New Delhi
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
0Organization of the manual0Content 0Format
Organization of the manual
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Areas covered in the trainingDrugs, Drug Dependence, Harm Reduction, Principles of drug treatment, OST:
• Basic knowledge (and attitude)
Assessment and Diagnosis:
• Clinical skills
OST (induction, maintenance, dispensing):
• Clinical skills
Psycho-social interventions:
• Clinical skills
Exposure to a functioning OST centre
Programme management: Dispensing, record maintenance, stock keeping, reporting, referral and linkage:
• knowledge , attitude and skillsPresented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Training sessions Day Sessions
Day 1
Introduction exercise: meeting strangers and building a rapportBasics of Drugs: Overview of drugs and drug use disordersDrug-related problems and harmsLocal drug abuse scenario – GROUP ACTIVITYGeneral principles of drug treatment and harm reduction
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Day Sessions
Day 2
Opioid substitution therapy – overview
Assessment and diagnosis
Assessment and diagnosis: ROLE-PLAY AND CASE DEMONSTRATION
Buprenorphine- pharmacology
Training sessions
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Day Sessions
Day 3
Implementing OST with buprenorphine: induction, stabilisation, discontinuationSpecial clinical situations – adolescents; women; HIV; other medical conditions, dual diagnosisPsychosocial interventionsROLE-PLAY / DEMONSTRATION OF PSYCHOSOCIAL INTERVENTIONSScheme for implementing OST in Government centres: an overview
Training sessions
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Day Sessions
Day 4
Exposure to the OST clinic, including demonstrationDEBRIEFING AND EXPERIENCE SHARING
Programme management–I Procurement and suppliesProgramme management–II Record maintenance and reporting
Training sessions
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Day Sessions
Day5
Programme management-III Referral and networking, engaging civil societyProgramme management-IV Minimum standards of care, reportingOpen session
Working together: meeting between stakeholders
Training sessions
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Content of each session
0Objectives 0Materials and method0Steps 0Highlights (as box items)0Contents of the presentation
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
0Organization of the manual0Content0Format
Organization of the manual
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Format
0 The manual has been designed to be available in two versions: 1. Hard copy:
0Description of all the sessions0Handouts of slides along with ‘notes’ for the
facilitator
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Format
0 The manual has been designed to be available in two versions: 1. Hard copy:
0Description of all the sessions0Handouts of slides along with ‘notes’ for the
facilitator 2. Digital version: (available as a CD or online)
0The manual proper as a pdf file0Power point presentations as hyper links
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Highlights of the manual 0 Developed as a ‘guide’ for facilitators
0 Not a substitute for practice guidelines or operating procedures
0 Flexibility for facilitators for local adaptation 0 Applicable to a variety of OST settings 0 Entire training programme has been designed to be
participatory in nature0 Strives to address all three components – knowledge,
attitudes and skills0 Manual encourages training programmes for mixed group
of participants
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Training on OST in India
0 Induction Training: Just after staff is recruited, before beginning the service delivery
0 Refresher training: about six months after beginning of services
0 Conducted by Psychiatrists from academic institutes
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
A pool of trainers has been created through
Training of Trainers (TOT) programmes
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Coming soon…
Online Training programme on OST0 Course content similar to existing training programme 0 Could be received by the registered participant at any
time and any place 0 Being developed by:
NDDTC AIIMS
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
1. Training
2. Quality Assurance / Mentoring
3. Accreditation
Capacity Building
Evaluation
NACO OST Programme: Mechanisms for building capacities and ensuring quality
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Quality Assurance of OST0 In the form of ‘visits’ by OST experts /
mentors 0 Visits aimed at:
0 Assessment of the quality of services0 Interaction with and guidance to the staff on
0 Staff receives hands-on guidance; 0 Authorities receive a report on performance Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Quality Assurance of OST0 In the form of ‘visits’ by OST experts /
mentors 0 Visits aimed at:
0 Assessment of the quality of services0 Interaction with and guidance to the staff on
0 Staff receives hands-on guidance; 0 Authorities receive a report on performance Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Atul Ambekar, Ravindra Rao, Alok Agrawal, Anju Dhawan, Rajat Ray, (2013), Quality Assurance of OST in India: A reference guide for mentors, NDDTC, AIIMS and NACO, Government of India, New Delhi
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
QA Guide: Contents
0 Introduction / About the Reference Guide 0 Conducting a Quality Assurance Visit0 Preparing a Quality Assurance Visit Report0 Tool for OST Quality Assurance Visit0 OST Quality Assurance Visit Report - Proforma0 Annexures: List of common problems and
their solutions; Steps for Planning and Managing QA Visits,
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Conducting a QA visit0 Inform the centre staff and concerned SACS prior to visit 0 During visit
0 Observation of the centre, including functioning of the staff and service delivery processes
0 Review of records0 Interaction with
0 Staff – OST centre0 Staff – linked IDU TI 0 Beneficiaries0 Other stakeholders
0 Use the prescribed format to conduct the visit 0 Use the prescribed format to report the visit
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Tool for OST quality assurance visit
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Section 1: Background information
Section 2: Details of the OST centre
Section 3: Staff-related Details
Section 4: Implementation Of OST
Section 5: Record Keeping-related Details
Section 6: Feedback from Clients and their Families