ABSTRACT
Background: There has been a rampant increase in substance abuse in Kashmir valley for the last few years. Department of Psychiatry SKIMS Medical College Srinagar has extended its services to cater to the needs of the substance users in the valley even during the COVID -19 pandemic. In 2021, de-addiction services were also started among prison inmates of central jail Srinagar. This was the first of its kind of services provided in the valley. The management of substance users with Hepatitis infections had also been challenging. Purpose(s): To describe the management of substance users under special circumstances(COVID-19), special settings(Central Jail Srinagar), high-risk groups(substance users with blood-borne infections). Method(s): Semi-structured proformas were used to collect data from special groups of participants a) those who were seeking treatment during COVID-19 times from the De-addiction center, SKIMS Medical College b) Prison in-mates on treatment for substance-use disorders c) substance users who are hepatitis B and/or positive. This included Socio-demographic details, clinical profile, the pattern of substance use, coping strategies, and treatment seeking. Preliminary Findings: More than 25 percent of the prison in-mates are substance dependent and relapse rate is very high. Psychiatric comorbidity like mood disorders and or personality disorders are present among most of the prison-inmates. During COVID-19 times, 90% patients reported average to very high level of importance and value given to their own health and health of family and friends and focussed on treatment of their illness(85%). Substance users with blood-borne infections were associated with highrisk behavior in the form of needle-sharing. Conclusion(s): The findings provide a voice that there is a need for backup plans that cater to the needs of substance users during in-evitable circumstances like the COVID-19 pandemic. Policymakers should focus on prison mental health for the functioning of a better society. Substance users with blood-borne infections should be rigorously treated to prevent them from taking the shape of an epidemic.
ABSTRACT
Background: Key Populations (KP) makeup 3.4% of the general population, yet account for ∼32% of new HIV infections in Nigeria (NACA, 2017). With criminalizing laws, and ∼3000 active KPs hotspots in Lagos state alone, it is increasingly challenging for civil society organizations to reach these groups with the much needed HIV services. With the COVID-19 outbreak in the South-West region of Nigeria, Lagos state in early March, 2020 and attendant lockdown leading to restriction in movement, it became even more challenging to reach KP members with a complement of comprehensive HIV services. We describe our experience implementing innovatively evidence and community-based strategies to scale active HIV case-finding using a COVID-19 guided protocol during the 6-week lockdown in the state. Methods: We set up 22 Community ART (cART) teams split into an 8-person KP peer-led sub team comprising (community health worker, pharmacist, laboratory technician, four counselor testers, and a community mobilizer) that conducted HIV Testing Services (HTS) in 78 communities across 7 districts using the "moonlight testing" (nightly testing) approach. The teams were equipped with a line-list of index clients for elicitation of sexual and needle-sharing partners. Community engagement of gate keepers of pre-mapped KP communities was innovatively conducted, to seek approval, grant access and provide security during testing of elicited partners. Following an orientation on COVID-19 protocols for clients assessing services, index partners who accepted HTS were provided HIV prevention information, condom messaging, demonstration and distribution;those who tested positive were retested and provided with ART immediately. Results: Prior to the lockdown (February-March 2020), 8,831 clients were offered HIV testing services with 1,396 (positivity yield of 16%). Following the lockdown period which lasted for 6 weeks (March-May, 2020), HIV testing among key population increased by 38% (12, 159) with a 28% increase (1, 781) in HIV positives and 15% positivity yield. Conclusion: Despite the pre-existing challenges with KP access to comprehensive differentiated services worsened by current COVID-19 realities, peer-led cART showed significant promise in accelerating KP HIV case finding and sustaining community ART delivery.