Issue
Harm Reduction Programme for PWID started in Bangladesh in 1998 and successfully kept the HIV prevalence low. However, this rate was significantly increased from 5.3% in 2011 to 22% in 2016 (p<0.001) in Dhaka city.
Settings
Three consecutive assessments conducted between 2018-20 demonstrated that outreach structures were traditional, and professionalism and motivation were lacked among Peer Outreach Workers (POW). These impacted the quality of outreach and overall harm reduction programme. In these circumstances, a series of initiatives were launched to address the gap in outreach services in 35 areas under 13 districts.
Project
With assistance from international and national experts, a series of initiatives were taken, including a guideline on POW selection and recruitment, training module for POW, initiating paring system in HIV hotspot (Peer and Non peer outreach workers together in a single team) and also increasing salary of outreach staff to improve their livelihood. Another important addition was contracting Network of People Who Use drugs (NPUD) to support in outreach and Needle and Syringe Program (NSP), and conducting advocacy through forming Task Force with the members of Law Enforcing Agency (LEA) to reduce harassment towards outreach staff and beneficiaries at field.
Outcome
After introducing massive redesigned in Outreach, positive changes have been observed in programme. In last one year, drop out of POW found less, which indicates clear change in their motivational status and good supportive environment at field. Also, changes have been reported in some important areas, such as consistent reach of PWID has increased from 68% to 95%, contact with PWID in 15 days in a month increased from 43% to 81%, collection of needle and syringes surpassed from 50% to 80%. HIV Testing Service (HTS) uptake was increased significantly, and HIV incidence was reduced to less than 1%.