Evaluation of a five-day training programme on opioid substitution therapy in India

Abstract

Aims: In India, opioid substitution therapy (OST) has been scaled-up in the recent years for HIV prevention among injecting drug users. This study aimed to assess the change in knowledge and attitude of the OST staff who underwent a five-day training programme on OST. Methods: Using a ''pre-test post-test'' design, routine data collected from 267 staff who underwent the OST training was analysed. The staff composition was: doctors (n ¼ 42, 15.7%), nurses (n ¼ 49, 18.4%), counsellors (n ¼ 45, 16.9%) and other programme staff (n ¼ 131, 49.1%). A 20-item, pen and paper questionnaire was administered right before the beginning of and immediately after the completion of the training. The questions were categorised into one of the five domains to assess whether changes in scores are confined to certain domains. Overall scores and scores in different domains were compared using paired-sample t-tests. The score difference in different cadres was compared using univariate general linear model with post-hoc comparisons. Findings: The difference between the total mean pre-test scores (9.24) (out of maximum possible score of 20) and post-test score (13.8) was significant. Comparison between various domains showed significant differences across all cadres. Doctors recorded significantly higher scores compared to other cadres. Conclusion: It is feasible to train different cadres of service providers together on OST in five days. The training was able to improve the participants' knowledge and their attitude towards injecting drug users.

Buprenorphine treatment receipt characteristics and retention among people who inject drugs at Integrated Care Centers in India

“…The Indian OST guidelines 25 for provision of buprenorphine recommend a lower daily maintenance dose of 8-12 mg compared to analogous guidelines in other countries 44,45 . While studies in many settings show that higher buprenorphine dose is associated with improved adherence and retention 46–51 , this recommendation in part was borne out of the earlier studies in India showing high retention with lower doses of buprenorphine 24,33–35,52,53 . However, even by the Indian OST guidelines, more than three quarter of PWID at ICCs received less than 8 mg of buprenorphine daily.…”

Research on opioid substitution therapy in India: A brief, narrative review

“…[ 21 ] A situation assessment conducted among 42 OST centers, supported by National AIDS Control Organization (NACO), reported that the mean dose of buprenorphine was 6 mg/day and 89% patients reported that they were satisfied with the dose. [ 22 ] The lower dose requirement of Indian patients is also reflected with methadone. The multicentric study on methadone[ 14 ] also reported the average dose of methadone required for each patient to be 40 mg/day, a dose much less than the minimum recommended dose of 60 mg/day in most international studies and guidelines.…”

The journey of opioid substitution therapy in India: Achievements and challenges

“…Sizeable proportion of clients (35%–40%) reported withdrawal and craving and used illicit opioids (28%). [ 36 ] There was an urgent need to improve the capacity of the staff working in OST centers to cater to the rapid scale-up of NACO OST Programme.…”

“…A study conducted to assess the effectiveness of induction training showed a significant improvement in the knowledge of all the staff cadres over the 5-day training. [ 39 ] We have also developed an online OST training for NACO in collaboration with the Public Health Foundation of India to further standardize the training. In keeping with the knowledge and experience of OST in India, we also have updated the NACO clinical practice guidelines for buprenorphine-based OST.…”