Number of injecting drug users (IDUs) on opioid substitution therapy

Export Indicator

Number of injecting drug users (IDUs) on opioid substitution therapy
What it measures

Medication assisted therapy program should be an access point for IDUs and the program should refer and link to ARV treatment programs, PMTCT for female IDUs and a range of other prevention services.

It is important to know how many people are reached in order to monitor how well programs are reaching IDUs with medication-assisted treatment.

This information can be used to plan and make decisions on how well an IDU audience is being reached with medication-assisted treatment. If a small percentage of the intended audience is being reached, then it would be recommended that activities are adjusted to improve reach. If a large percentage of the intended audience is being reached, then headquarter staff would want to take these lessons learned and disseminate them to other countries. The country can use the information to improve upon the quality of the program as well as scale-up successful models.

Rationale

Medication-assisted treatment programs have been demonstrated to be an effective HIV prevention strategy. Substance abuse treatment reduces the frequency of drug use which in turn reduces HIV risk behaviors (Metzger, 1993, Gowing, 2008, and IOM, 2006). It also improves adherence to disease treatment regimens (Gowing, 2008 and IOM, 2006). Treatment modalities include non-pharmacological and pharmacological approaches; often, a combination of the two is used (National Institute on Drug Abuse, 1999b). An extensive body of evidence shows that medication assisted therapy (MAT) reduces the frequency of heroin injection and improves substance abuse treatment retention (Gowing, et al, 2008). Methadone maintenance therapy (MMT) is associated with reduced HIV risk behaviors including reduced frequency of injecting and sharing of injection equipment, reductions in the number of sex partners, and exchanges of sex for drugs or money (Gowing, et al, 2008)

Numerator

Number of injecting drug users (IDUs) on opioid substitution therapy

Denominator

Total estimated number of IDUs
*Recommended at partner level only

Calculation
Method of measurement

Explanation of Numerator:
The numerator is generated by counting the total number of individuals who have been on treatment for at least 3 months since initiation of opioid substitution therapy or medication-assisted treatment (e.g. using methadone or buprenorphine to treat drug dependency in order to reduce frequency of injections and potentially reduce other behavioral risk factors) at any point in time within the reporting period. The numerator should equal the number of adults who initiated and remain on opioid substitution therapy or medication-assisted treatment for at least 3 months prior to the end of the reporting period. Adults who initiated or transferred in during the reporting period should be counted only if they have been on treatment for at least 3 months after initiation prior to the end of the reporting period.

Count all individuals who complete at least 3 months of treatment even if they drop-out, die, or are otherwise lost to follow-up. Do not count individuals who initiate treatment too late in the reporting period to be able to reach a minimum of 3 months. These individuals will be counted in the next reporting period assuming they complete at least 3 months of treatment. For example: If an adult initiates his/her treatment in the last few months of reporting period, however, s/he does not complete at least 3 months in treatment before the end of the reporting period, then count this individual in the next reporting period.

It is highly recommended that PEPFAR Teams have systems in place to monitor individuals who have been on opioid substitution therapy or medication-assisted treatment for different time intervals: for at least 3 months, for at least 6 months, for at least 12 months, etc.

Partners providing referrals only should not use this indicator. See MARP Indicator XX for possible alternative.

Explanation of Denominator (recommended at partner level):
Catchment area: Geographic region from which persons come to receive HIV prevention services, or from which persons are being recruited into HIV prevention services. The size and population of this area can vary, depending on organization or agency and the services provided. IDU estimates for subdistricts/districts/regions can be used if available.

The percent coverage can be determined if both the numerator and denominator are included. Country teams can encourage their partners to consider ways to estimate denominators, using similar methods used in estimating targets.

Measurement frequency

Continuously

Disaggregation
Explanation of the numerator
Explanation of the denominator
Strengths and weaknesses

This indicator provides information on the total number of IDUs that received medication-assisted therapy. These interventions are based on evidence. The information collected will allow the country and the PEPFAR to assess any changes in risk behaviors as a result of the implemented interventions. The information will also help the country to understand the efficacy and effectiveness of evidence-based interventions and help in further expansion of similar interventions.

Further information