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अखिल भारतीय आयुर्विज्ञान संस्थान, नई दिल्ली
All India Institute Of Medical Sciences, New Delhi

Community Based Treatment Programme

 

Community Based Drug Treatment Services

 

Philosophy of community based treatment

 

Community based drug treatment approach is a key strategy to reach out to individuals using alcohol and/or drugs, afflicted families and vulnerable groups who may not be able to avail these facilities on account of difficulty in access, social stigma and other factors. The advantage of community-based treatment is that treatment is available at the doorstep and flexibility can be maintained in delivery of services. It also facilitates family and community participation. Community based drug treatment is provided on an outpatient basis, and is managed with minimal staff with a ‘low threshold’ apprach. The treatment services are located closer to the community, which makes it easy for the community to access the services needed for individuals in-need.

 

Treatment goals

The goals of these services are:

  • Outpatient management of withdrawals (detoxification) of alcohol and drug dependents in the locality / catchment area
  • Provision of long term pharmacological and psychosocial services
  • Prevention of relapse
  • Facilitating retention in treatment
  • Facilitating rehabilitation including re-establishment of family bonds and re-integration of patients into the community.
  • Creation of awareness in the community of the existence of alcohol and other problems in their environment.
  • Development of a sense of responsibility on the part of the public and voluntary organizations in enhancing treatment seeking and supporting relapse prevention and rehabilitation

NDDTC has been implementing community based treatment programmes at three locations in Delhi.

 

A. Community Clinic, Trilokpuri, New Delhi

 

(Faculty in-charge:Dr Ravindra Rao; Dr. Alok Agrawal, Dr Roshan Bhad)

Timings of clinic: 8.00 AM to 4.00 PM evryday

(Closed on Sunday & Holidays)

Address:

Community Drug Treatment Clinic

MIT Rotary Eye Hospital

All India Institute of Medical Sciences

Block 2, Trilokpuri

New Delhi – 110 091

 

Community Clinic, Trilokpuri, New Delhi was started in December 2003 as part of community drug treatment services of the National Drug Dependence Treatment Centre (NDDTC). The clinic was started to develop a model for low-cost, low-threshold treatment through availability of limited manpower and resources. Initially, a needs assessment survey was conducted. Awareness in the community was spread through locally acceptable methods such as drum announcements, information in the cable television and meetings with local leaders. The clinic in located in the heart of Trilokpuri and is easily accessible to people from Trilokpuri and adjoining areas.

 

Staff Team

A qualified and committed multidisciplinary team is managing the community clinic. The clinical staff includes faculty in charge (currently Dr Ravindra Rao), two more faculty members, senior resident doctor (acad-pursuing DM (addiction psychiatry), Senior resident (non-acad) and junior resident doctor (pursuing MD, psychiatry), two staff nurses and a Medical Social Service Officer (MSSO). The ancillary staff includes medical record peon, an orderly and a guard and support staff. The doctors and the MSSO are available on two days in a week (Monday & Thursday). The other staff is available on all six working days.

 

Services at the clinic

The clinical staff assesses the new patients attending the clinic and formulates a management plan with immediate, short-term and long-term goals and objectives. Screening for the co-morbid medical illnesses is performed. Patients are referred to the nearest multi-specialty hospital for investigations for co-morbid physical illness, if required. In follow-up visits, patients are evaluated regularly and feedback is taken from the family members as well. In a few cases requiring admission, referral to NDDTC for admission is made.

The MSSOs are trained in psychosocial interventions including brief intervention, motivation enhancement, relapse prevention and family interventions. Home visits are made as and when required. The staff nurses in the Community Clinic, Trilokpuridispense medications to the patient, participate in psychosocial rehabilitation and provide support and care to patient and family members.

People served / catchment area

The catchment area of ‘Community Clinic, Trilokpuri, New Delhi’ includes the area in the radius of 5 kilometers. The patients and family members from these areas can seek advice and treatment for drug / alcohol problems at ‘Community Clinic, Trilokpuri’

 

Additional Activities that have been carried out so far

  • Training of General Duty Medical Officers working in the dispensaries run by Delhi Government in the area
  • Sensitization of paramedical personnel/Anganwari workers
  • Meetings with NGOs working in the area
  • School based awareness programme

 

Profile of patients

On an average each month approximately 2000 patient visits are made in‘Community Clinic, Trilokpuri New Delhi’, that includes around 20 new patients and the rest are follow up cases. Approximately 70 patients visit daily. The majority of the follow up patients are Opioid dependent patients receiving agonist maintenance treatment (also known as Opioid Substitution Therapy, OST). For this purpose, various pharmacological options are used: buprenorphine, buprenorphine-naloxone, Slow Release Oral Morphine (SROM) etc. There are some opioid dependent patients on antagonist maintenance (Naltrexone) as well. Patients with Alcohol dependence are also treated using appropriate combination of psychosocial services and long-term medications (such as Disulfiram).

 

Services and facilities available

Ø Alcohol Dependence

o Outpatient detoxification (using benzodiazepines)

o Inpatient detoxification at NDDTC (referral)

o Long term pharmacotherapy

§ Deterrent medication: Disulfiram (dispensed free of cost)

§ Anticraving medication: Acamprosate (to be purchased by patient), Naltrexone

o Psychosocial interventions

Ø Opioid Dependence

o Outpatient detoxification

o Inpatient detoxification at NDDTC (referral)

o Long term pharmacotherapy (Free of cost)

§ Agonist maintenance: Buprenorphine (directly observed therapy), Morphine SR (directly observed therapy), Buprenorphine-naloxone

§ Antagonist: Naltrexone (directly observed therapy)

o Psychosocial interventions

Ø Nicotine Dependence

o Nicotine replacement therapy: Nicotine gum (to be purchased by patient)

o Bupropion and nortryptilline (to be purchased by patient)

o Psychosocial interventions

Ø Other drugs (benzodiazepine, inhalants, cannabis, etc.)

o Outpatient detoxification

o Inpatient detoxification at NDDTC (referral)

o Psychosocial interventions

Ø HIV/AIDS

o Pre and post testc ounseling

o Referral to nearest centre for testing (HIV, CD4, etc.) and antiretroviral medication (ART)

o Counseling and behavioral interventions with focus on harm reduction, condom usage and other safer practices

Ø Non pharmacological interventions

o Instillation of hope

o Psychoeducation

o Motivational enhancement therapy

o Relapse prevention therapy

o Alternative therapies: Yoga

Ø Family interventions

o Psychoeducation

o Family counseling

Ø Social/community interventions

o Occupational rehabilitation facilities. Attempts are also made sometimes to facilitate provision of small financial help in the form of micro-credit to the needy patients.

o School based awareness

o Interactions with NGOs, local authorities (bank, post office, etc.), community leaders, etc.

Ø Other activities

o             Training of doctors from government dispensaries

 

 

B. Community Opioid Substitution Therapy Clinic, SunderNagari, New Delhi

 

(Faculty in-charge:Dr.Sonali Jhanjee; Dr. Ravindra Rao; Dr Roshan Bhad)

Timings of clinic: 8.00 AM to 4.00 PM evryday

(8.00 AM to 1.00 PM on Sunday & Holidays)

 

Address:

Community Drug Treatment Clinic

Community Centre

F2 Block, Sunder Nagari

New Delhi - 110093

 

As a part of its community based treatment program, NDDTC is also running a community buprenorphine based opioid substitution therapy clinic at SunderNagari, in New Delhi. This area is inhabited largely by people from lower socio-economic strata. The clinic is currently located in the premises of a community marriage hall managed by the Delhi Urban Shelter Improvement Board (DUSIB).

 

A unique feature of the clinic is that it is co-located with methadone clinic run by NDDTC as well as a Drop-in-Centre managed by a NGO implementing Targeted Interventions for Injecting Drug Users supported by National AIDS Control Organisation through Delhi State AIDS Control Society. Currently, the clinic offers services to those individuals residing in Sunder Nagari area only.

 

The clinic is managed by a doctor (senior resident), one nurse, and a MSSO, along with ancillary support staff, besides the faculty in-charge. The doctor and MSSO is available for two days (Tuesday and Friday), while other staff is available on all weekdays including public holidays.

 

The treatment philosophy and modality is similar to that followed in Trilokpuri community clinic, except for the fact that only opioid dependent individuals requiring long-term agonist maintenance treatment are catered to in this clinic. The doctor conducts an initial assessment and community based services are provided to those requiring long-term agonist maintenance treatment. Other patients are referred to NDDTC, AIIMS for further treatment. Buprenorphine is dispensed to the patients daily on a ‘Daily-Observed-Treatment’ basis.

 

Patients requiring other health related services such as general medical care, HIV testing, anti-retroviral treatment, tuberculosis diagnosis and treatment, etc. are referred to the nearest health facilities located in the vicinity. Similarly, tie-up with the NGO working in the premises is also done to ensure provision of harm reduction services as and when required.

 

The clinic has registered more than 622 patients till date, and about 50 patients visit the clinic on a daily basis for their buprenorphine dose.

 

Methadone Maintenance Treatment (MMT) Clinic

(Faculty in-charge:Dr. AnjuDhawan; Dr.AtulAmbekar; Dr. Ravindra Rao)

Timings of clinic: 8.00 AM to 4.00 PM evryday

(8.00 AM to 1.00 PM on Sunday & Holidays)

 

 

Another new initiative at the Sunder Nagari Community, New Delhi is a Methadone Maintenance Treatment (MMT) clinic. This was initially a part of the project “Methadone Maintenance Treatment in India: A multi-site feasibility and effectiveness study” started. This treatment service has been initiated in India in August 2012 in five government hospitals (NDDTC, AIIMS; Civil Hospital Kapurthala; Civil Hospital, Bathinda; King Edward Memorial (KEM) Hospital, Mumbai and Regional Institute of Medical Sciences (RIMS), Imphal) with support from United Nations Office on Drugs and Crime (UNODC). This multi-site initiatives being coordinated by the National Drug Dependence Treatment Centre (NDDTC), AIIMS. MMT increases the treatment option for opioid dependent patients as this medication has been widely used across the world as an effective treatment and HIV risk reduction strategy. Through this initiative, procedures required for scale-up of Methadone Maintenance Treatment in the country will be documented.

 

The MMT clinic at Sunder Nagari has since been functional since August 2012. The clinic is located in the premises of a community marriage hall managed by the Delhi Urban Shelter Improvement Board (DUSIB). A doctor and MSSO are available for two days a week. The staff nurse, on the other hand, is available for all the days of the week, including Sundays, for dispensing of medicines at the clinic. Other ancillary staff is available on weekdays, while a guard is posted round-the-clock in the clinic premises.

 

Opioid dependent patients who require long-term agonist medication are catered to in this clinic. The doctor conducts assessment of the patients for their suitability to methadone, and prescribes methadone. Methadone is dispensed as a liquid by the nursing staff. The patients have to visit the clinic daily for their dose of methadone. The counselor conducts psychosocial assessment, motivation enhancement, family intervention, relapse prevention, psycho-education, and home visits, as required. A unique feature of the clinic is that it operates with an active collaboration with a NGO working with Injecting Drug Users, which provides the outreach services. Apart from direct services, referral services to other healthcare facilities in the vicinity are provided by the MMT clinic.

 

Since its inception in August 2012, the clinic has registered more than 661 clients.

 

 

 

 

 

 

C. Community Drug Treatment Clinic, Kotla Mubarakpur, New Delhi

 This clinic was started as a part of DTC scheme under Drug De-Addiction Programme (DDAP) of Ministry of Health & Family Welfare, Government of India. The clinic was started in March 2017 and currently runs on Wednesday & Saturday.

(Faculty in-charge:Prof Atul Ambekar; Dr. Alok Agrawal)

Timings of clinic: 8.00 AM to 4.00 PM evryday

(Closed on Sunday & Holidays)

 

 

 

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