Min Zhao, M'D

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Synthesizing Promising Practices on the Role Of
Drug Dependence Treatment in HIV/AIDS Prevention
and Care

• Min Zhao, M.D Ph.D.
• Shanghai Drug abuse treatment center
• Shanghai Mental Health Center

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Working Group Members

• Turning Point Alcohol and Drug Centre Inc.,
  Australia
• SSTAR Stanley St Treatment Resources, Inc.,
  USA
• Shanghai Drug Abuse Treatment Center
• Shanghai Mental Health Centre, China
• Drug rehabilitation Unit
• Mathari Hospital, Kenya
• Laboratory of Clinical Pharmacology of
  Addictive States
• Valdman Institute of Pharmacology
• Pavlov State Medical University, Russia

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Background

• Interaction between HIV/AIDS and drug abuse
• Both HIV/AIDS and drug abuse is an international
  public health challenge
• International collaborations are needed to
  address both issue
• Drug abuse treatment as a effective intervention
  for HIV/AIDS prevention and care
• Diversity of politics, cultures, economy in
  different part of the world produce different
  practices
• Synthesizing Promising Practices will help to
  address both drug dependence and HIV/AIDS
  internationally

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Objectives of treatment

• Multidimensional objectives
• reduce dependence on drugs
• reduce the morbidity and mortality
• reduce drug related problems
• improve physical and psychological health
• reduce criminal behaviors
• facilitate reintegration into the society
• improve social functioning
• One of the main objectives is reduce drug use
  related problem such as infectious diseases, for
  example HIV, HCV and TB, etc.

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Principles of effective drug dependence treatment

• Treatment programmes should provide assessment
  for HIV, HCV, HBV, TB and other infectious
  diseases and provide help and means to modify
  risk behaviour
• --A research based Guide (NIDA 1999)

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Objectives of working group

• Product a promising practice document on the role
  of drug abuse treatment in HIV/AIDS and HCV
  prevention and care
• Promote sound public health policy and for
  practitioners to deliver quality interventions in
  the treatment of drug abuse
• Establish a sustainable platform for exchange on
  state of the art drug abuse treatment with common
  and shared objectives
• Establish connections with other networks working
  in the same area
• Dissemination of the best practice document

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Methods

• Group coordinator/lead centre
• Distribute tasks within working group drafts,
  literature review, data collection, peer reviews,
  case studies, feedbacks, revise, etc.
• Exchange of information and ideas
• Discussions, Extensive consulting
• Physical meetings
• Monitoring, review and reporting

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Outlines of Practice Document

• Title The role of drug treatment in HIV/AIDS
  and HCV prevention and care promising practice
• Brief introduction
• Definition of drug treatment (broad)
• Target grouptreatment providers, Policy makers,
  etc.
• Treatment settings
• Core drug treatment components for effective HIV
  prevention and care
• Detail each core components definition,
  literature review, good practice principles, case
  example
• Human resource development
• Monitoring, Evaluation and record keeping

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Core Components

• Pharmacotherapy treatments methadone,
  buprenorphine, Natrexone, and others
  substitution withdrawal
• HIV and HCV (and other?) testing and counseling
• HIV/AIDS (and other?) education (such as safe sex
  and safe drug use)
• Affordable ARVs and other relevant medications
• Clean needles and syringes

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Core Components

• Withdrawal services residential, non-residential
• Psycho-social treatments brief interventions,
  motivational interviewing, CBT, relapse
  prevention , etc.
• Outreach services targeting high-risk groups
• Support (wrap-around) services (eg. Vocational
  training, housing, financial support)
• Policy advice and advocacy

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Resources

• Already existing documents in this area
• Existing resources and experiences of working
  group
• Prevention programs, education
• Pharmacotherapy, harm reduction
• Community services home based, outpatient,
• Rapid test, counseling, pre-test counseling and
  post-test counseling
• Withdrawal services, HIV education, training
  platform
• Platform to learn from each other
• Program development

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Challenges

• Get agreements on core drug dependence treatment
  components for effective HIV/AIDS prevention and
  care
• Cultural, economical and political diversity
• Agreement of the definitions eg. Best practices
  or promising/good practices?
• Potential duplication with other existing
  documents
• Other commitments
• Language barriers

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