5 Clinical and Support Services
• take-home doses are available so that users do not have to attend the service daily
• the service is mobile and can be transferred to another location, should the user require it
• the service is integrated with a range of other support and care services, including NSPs.
OST and NSPs should not be treated as mutually exclusive, and accessing NSPs while enrolled in an OST programme should never be used as evidence by service providers that a person is no longer suitable for the OST programme.
5.5.3 Needle and syringe programmes
NSPs are cheap, easy to establish and have proven to be highly effective in reducing HIV transmission among people who inject drugs without increasing injecting behaviour. NSPs are best delivered at the community level and are an important point of first contact with people who inject drugs who are reluctant to use other services for fear of discrimination or abuse. The most effective NSPs:
• are community-led, with community members trained to deliver the service, including first aid
• are located close to where people who use drugs are
• are mobile and adaptable to the changing patterns of the drug-using scene
• offer a range of needle and syringe sizes( including those with low dead space between needle and syringe) and other essential injecting equipment, without any restrictions on the number of needles
• offer a range of other support and care services, such as legal aid, nutrition, family and housing advice, as well as health maintenance, like vein care and abscess avoidance and care
• offer overdose prevention, either by ensuring all staff are trained in overdose revival techniques or by providing naloxone to people who inject drugs and their families and community members..
5.5.4 Other considerations
Up to 90 % of people who inject drugs in some countries are infected with HCV. NSPs should also provide other injecting equipment, such as cookers, swabs and bleach in order to prevent HCV. There is evidence that providing low dead space syringes( LDSS— which are designed to reduce the amount of blood remaining in the syringe after completely pushing down the plunger) reduces the risk of HIV and HCV transmission. NSPs should therefore provide LDSS in addition to other syringes appropriate for local needs.
Because injecting drug use is criminalized in many countries, and NSPs are generally highly visible, it is essential for those considering the establishment of such services to engage at a very early stage with the police and the wider community in order to gain their support.
Injecting equipment may also be shared by other communities, such as transgender women, who may use it for breast augmentation or hormonal therapy. It is essential to ensure that these people have access to the range of services they require to keep themselves safe.
It is also important that any service in contact with people who inject offer HBV vaccination( see Section 5.6.2, part D).
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