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INTRODUCTION TO OUTREACHA systematic approach of delivering HIV prevention services to people injecting drugs in their environments.

WHAT DOES OUTREACH MEAN? WHY SHOULD WE DO OUTREACH?Conventional service delivery approaches have not proved effective for IDUsMajority of IDUs are not ready to accept HIV prevention as their responsibilityOutreach service seems more acceptable to IDUs and in addressing their needs HIV prevention requires rapid & wide scale coverage within shortest possible timeOutreach often links IDUs with other services

3WHAT CAN OUTREACH ACHIEVE? Overall Objective: To prevent transmission of HIV & other blood borne viruses among IDUs

Specific Objectives:To ensure IDUs have easy access to and utilise available servicesTo ensure significant reduction in needle sharing and unsafe sexual contactTo prevent drug use related harmsTo mobilise the IDU communityWHAT ALL DOES OUTREACH INVOLVE?Effective & detailed outreach planningFinding & contacting IDUs at places where they live, work, buy, sell and use drugsBuilding rapport with IDUs so as to ensure their full participationProviding IDUs with information and materials to prevent HIV and other BBVLinking them with DIC, ICTC, ART, STI clinic, DOTS Centre, OST services, general health services, detoxification and rehabilitation centres and other welfare servicesProviding services- NSEP/condom on a regular basis as and when the client needs itPRINCIPLES OF OUTREACHInformation collected in the process of outreach (planning & conducting) should remain confidentialOutreach should be consistent & adequateOutreach should be flexible in order to meet the needs of IDUsOutreach done in isolation is less effectiveOutreach should ensure active involvement of IDUs Outreach efforts must address both injecting as well as sexual risks of IDUs & partners

6CONDUCTING OUTREACHOutreach (planning and conducting) is the most important activity of a TI programmeOutreach requires careful planning and coordination among staff of the TIThe quality of outreach determines outcome of the programmeConstant monitoring and re-planning (of outreach) is required to reflect & address the changing patterns & needs of IDUIntroductionSTEPS IN CONDUCTING OUTREACHStep 1: Building rapport with the IDU and general community

Step 2: Delivering services in the field; referrals to DIC and other services

Step 3: Creating enabling environment for effective delivery of and access to services

Step 4: Documenting and analysing collected data for re-planning/re-strategising outreach CONDUCTING OUTREACH - STEP 1Building rapport/trust with the IDU and general community

It is the first step towards conducting street/community outreach. This is a time consuming task and an ongoing process. A good rapport will enable the outreach team to deliver services effectively without the interference of the general communityCONDUCTING OUTREACH - STEP 2Delivery of Services Ensure outreach plan is readyBefore initiating outreach services, the outreach team should have a detailed outreach plan ready. On the basis of the detailed plan, timing of services, area of delivery, delegation of PE etc. should be decidedEvery effort should be made to cover each and every IDU with servicesIDU should be tracked periodically to ensure consistent use of safe N/S and condoms through individual tracking mechanism

11STEP 2 CONTD. The following are provided during outreach:Risk reduction sessions/messages (through Interpersonal Communication, IPC)Materials (including needle/syringe and condom)Services including BCC, return of used N/S, referrals, abscess management (if simple), Overdose management/preventionCONDUCTING OUTREACH - STEP 3Creating Enabling Environment

A safe and supportive environment is required for effective delivery of services and assisting the IDU to access available services without fear or stigmaAn analysis of the barriers to conducting outreach should be conducted with peers and communityAn enabling environment can be created by carrying out community advocacyCONDUCTING OUTREACH - STEP 4Documentation and Analysis

Outreach conducted (data) should be documented using tools provided by PMA weekly analysis of the data should be done by ORW with PE and IDUThe analysis should focus on:Whether all IDUs are being coveredWhether all IDUs are being covered regularlySTEP 4 CONTD.What are the barriers to accessing services?How to strengthen service uptake?Outcome of the analysis should be shared with relevant staffIn case the outreach team is unable to address gaps, help should be sought from the PM and other senior staffJoint periodic reviews should be conducted to avoid duplication of coverageMANAGING PEER EDUCATORSMANAGING PEsORW need to manage their PE through:Understanding common problems with PEKnowing how to support PE Building capacity of PEMentoring PEEvaluating the work of PE through supervision and monitoringCOMMON PROBLEMS WITH PEsDifficulty keeping own drug use under control

Conflict between being a professional health care worker and maintaining peer status

Occupational stress associated with demanding nature of peers

Lack of supervision & support can affect self-discipline

Lack of professional status, acknowledgement of work undertaken and measurable outcomes prove frustrating18HOW TO SUPPORT PEs? Identify areas of technical support and training for each PE and forward this information to the Project Coordinator/ Manager

The ORW should make a point to praise their PE for a job well doneBUILDING CAPACITY OF PEsCapacity of PE can be built through both in-house formal training and on-the-job training

The capacity building should be ongoing

Technical skills related to health issues (HIV/AIDS/STI/Hep B & Hep C) and harm reduction should be developed in PE

Life skills like negotiation, communication and leadership should be developed in PE

Training should be interesting & simple20MENTORING PEs (dos and donts)Be yourself & allow the PE to be themselves

Be a good listener

Don't attempt to handle situations with PE for which you are not qualified

Clearly outline & discuss PE responsibility

Be available21CONTD.Monitor PEs progress

Follow up on commitments made

Be realistic with your PE and encourage them to explore options when appropriate

Do not betray confidential information

Goals and accountability should be encouraged throughout the mentoring process22EVALUATING THE WORK OF PEsAssist PE to understand objectivesDevelop a weekly work plan with PE; include targets and follow-up plansFollow up on weekly achievementsAnalyse results of PEs work with PE keeping objectives/goal in mindMeet with PE peers to gauge extent of information and services providedDiscuss your findings with PE23