Table 1 Key strategic information gaps and proposed solutions for people who inject drugs identified within small group discussion
Group number | Discussion topic | Identified gaps | Recommendations |
|---|---|---|---|
1 | Identifying, reaching, and testing people who inject drugs (PWID) | ● Populations of females who inject drugs are underrepresented | ● Programs should also be able to identify emerging risk behaviors; they could gather information in both formal and informal ways |
● Population size estimates are not accurate | ● Separate Cascades would allow data collectors to capture subgroups within the larger PWID groups | ||
● Delays in estimating population size within surveys are slowing testing and uptake because services are not provided where PWID are located | ● Use programs more strategically for data collection along the Cascade | ||
● Reach of programs depends on political and legal environments. There is limited information from closed settings, such as prisons | ● Use peer educators and PWID drop-in centers for care and support | ||
● Link with hospitals and other treatment sites for referrals | |||
2 | Testing PWID and enrolling them in care and treatment | ● Limited data on how many PWID living with HIV are actually in care and treatment | ● Community-based testing should be scaled up |
● Lack of linkages between PWID-focused programming and HIV care and treatment programming | ● Scale up the use of HIV rapid tests using oral fluid samples, which are more convenient and preferable to most people | ||
● Stigma and discrimination prevent members of key populations from seeking testing services | ● Periodically test MMT clients for HIV when they receive their methadone | ||
● Challenges in ensuring anonymity when tracking people along the Cascade | ● Use a mix of different approaches, different entry points into the Cascade in SI collection | ||
● The testing service delivery model could be more targeted | ● Mix program and surveillance, community support, and case management | ||
3 | Gaps in strategic information; challenges and solutions for retention of PWIDs in care and treatment | ● Uneven coverage of drug dependence treatment and OST | ● Integrated MMT and ART services |
● Uneven coverage of peer/family/social support | ● Establish models of peer-administered ART delivery or limited peer-peer interventions to improve adherence | ||
● Difficult to disaggregate data by risk behavior or key population group | ● Ask clinicians to collect risk group/behavior status | ||
● Information by risk group is not used to inform the Cascade | ● In IBBS/surveys, include biomarkers for ART use in testing and data collection to inform ART uptake and viral suppression pillars within the Cascade | ||
● Lack of data on reasons for loss to follow-up and on mortality | |||
4 | Respectful approaches to data collection | ● “Respectful” can mean different things to different people | ● Protect PWID identities through encryption and unique identifier codes |
● There are different clearance requirements for different countries | ● Adopt the human rights framework for SI activities | ||
● The meaning of community can vary, and this can challenge how PWID communities are integrated in data collection | ● Consider the community-based participatory research framework | ||
● It can be difficult to guarantee anonymity | ● Ensure that services are available for the kinds of problems that are being investigated. For example, needle distribution and MMT programming should be identified before initiating a study that intends to refer participants to these services upon request | ||
● How to get people to disclose behaviors/practices that are criminalized | ● Require funders of research to accept responsibility for guaranteeing anonymity |