Needle Syringe Exchange Programmes

1. Needle Syringe Exchange Programmes

2. OBJECTIVES • By the end of the session, participants will have understood: • Key objectives of Needle Syringe Exchange Programme (NSEP) • Operational aspects of NSEP (what, where, who, how and when) • Collection and Disposal of used Needle/ Syringes (N/S) • Importance of NSEP in an HIV prevention programme

3. GOALTo ensure that every injecting act iscovered with a safe needle/syringe

4. KEY OBJECTIVES OF NSEP • To facilitate safe injecting practices by: • Providing Sterile/Clean/ New injecting equipment • Practicing safe disposal option • Removing contaminated needles/ syringes from circulation

5. KEY OBJECTIVES OF NSEP • To educate and inform IDUs & partners about safe injecting practices for prevention of HIV transmission thereby minimising the hazardous consequences of unsafe injection • To befriend the IDU for establishment of a line of communication that ultimately links them with other services & assists in reduction of high risk practices/ behaviour

6. BASIC COMPONENTS • Distribute • Collect • Dispose & Inform

7. WHO WILL IMPLEMENT NSEP? • PEs & ORWs in: • Areas where IDUs congregate/reside • Health Workers (nurse/counsellor/ANMs) at: • DICs/Clinics • PEs/Others designated as Secondary Distributors (SD) in: • Far flung areas difficult for ORW/PE to reach • Sometimes, NSE may be implemented by a local key informant

8. WHERE? • Static/Fixed sites – Clinics or DICs • Outreach Teams - on predetermined routes • Mobile clinics (not practiced in TIs currently)

9. WHAT WILL BE DISTRIBUTED? Needles: 24”, 26” Syringes: 1ml, 2ml, 5ml, 10ml Other equipment: filter, cooker, tourniquet (where budget permits) Need based IEC Alcohol/ spirit swabs (to prevent abscesses) Swabs, bandages, etc (to manage abscesses) Condoms Distilled Water Commodity Distribution

10. NSEP – OPERATIONAL ASPECTS • NSEP should operate all 7 days in a week • At times when IDUs need it most • A carefully planned outreach will determine • locations for delivering NSEP • Number of N/S required • Timing of operation • Division of IDUs & areas amongst the outreach team • Individual tracking and monitoring

11. NSEP – OPERATIONAL ASPECTS • N/S distribution should be accompanied by IDUs returning used N/S • However, the return should not be a prerequisite for distribution • Collection of used N/S from IDUs reduces number of used N/S available for recirculation and risk of contamination/sharing • The return rate of N/S depends on: • The relationship between IDU and staff • Conducive environment for NSE

12. NSEP’S SUCCESS DEPENDS ON: • Easy accessibility of N/S • Confidentiality of the IDU and partner • many IDUs are fearful of being identified and seen as an IDU by the public and family/friends while accessing NSEP • Supply (delivery) meeting demand • The behaviour & attitude of outreach staff during interaction with IDUs & partners

13. DISPOSAL OF USED NEEDLE AND SYRINGE

14. WHY DISPOSE N/S? • Contaminated N/S can cause infections or diseases including HIV, Hepatitis B & C • Improper disposal of N/S may result in: • Others re-using them • Objection /outrage of general community • Children accidentally pricking themselves while playing • Transmission of infections through rag pickers who may resell them

15. HOW TO DISPOSE USED N/S? • Inform IDUs/partners regarding disposal of used N/S through following steps: • Exchange used N/S for a new one at the DIC or in the field from PEs/ORWs immediately after use • If above is not possible, take it home & store it until it can be collected by a staff • Store it in such a place where it cannot be used by children and others including other IDUs/partners

16. HOW TO DISPOSE USED N/S? From field to DIC/Collection Room: • Collection of used N/S should be done in a puncture proof box • Puncture proof box can be made of tin, thick plastic easily available in local shops 1. The walls of the box should be thick enough that needles do not pierce the box from the inside and prick someone handling the box

17. HOW TO DISPOSE USED N/S? From field to DIC/Collection Room (cont’d): • Close the box securely (top AND bottom) with sticky tape and/or staples • Cut a small hole in the top just big enough for a syringe & needle to enter • Insert the N/S into the small opening of the safety box immediately after the IDU/partner returns it • Do not recap

18. HOW TO DISPOSE USED N/S? From field to DIC/Collection Room (cont’d): • Do not separate needles from syringes • Do not place fingers inside the opening • Close the flap of the box when it is 3/4th full. Do not overfill • The used N/S collected in this manner should be brought to the DIC and stored in large puncture proof containers • The puncture proof containers should be secured in the DIC & labeled accordingly

19. MATERIALS NEEDED TO DISPOSE USED N/S • Puncture proof boxes-serially numbered, marked with biohazard symbol • Thick colour coded plastic bags-marked with biohazard symbol • Thich rubber gloves • Tongs/large forceps • Plastic bin with sieve • Plastic bin without sieve • Disinfectant solution- sodium hypochloride, bleach, large plastic bins (transculent white or blue coloured) • Hub cutter for mutilating disinfected syringes, if syringes are disposed off by burial on site

20. DISPOSAL OF USED N/S

21. COLLECTION OF SCATTERED N/S

22. COLLECTION OF SCATTERED N/S • Often used N/S lie scattered in fields/hotspots • These might prick children or be reused by other IDUs causing transmission of infection • A 1-day activity should be organised periodically by the TI to gather these N/S • Use the IDUs/PE/ORW for this activity • Inform the general community beforehand • Explain the importance of the activity • The local police thanas can also be informed

23. COLLECTION OF SCATTERED N/S

24. COLLECTION OF SCATTERED N/S • While collecting scattered N/S from the field/hotspots: • Wear latex plastic gloves (thick gloves, not the one used in clinics) • Do not recap N/S • Do not bend/break N/S manually • Use puncture/leak proof containers with proper lid for collection and transportation of used N/S

25. COLLECTION OF SCATTERED N/S • Always pick up from the barrel-end (syringe-end) - away from the needle • Use a tong, if possible, to pick up • Definitely use a tong to pick up if more than one N/S; separate each with a stick and pick up each N/S separately

26. COLLECTION OF SCATTERED N/S • Put the N/S into the puncture proof container ensuring that needle-end faces downwards to avoid accidental injury • Secure the lid of the container tightly • Avoid manual (direct hand) transfer of needles /sharps waste from one container to another • Transfer collected N/S directly into the main sharp container placed in the DIC

27. NEEDLE STICK INJURY! WHAT SHOULD ONE DO? • Wash the injured site with soap and water • Do not suck or lick the injured site • Contact /inform a supervisor (PM, counsellor of DIC)/doctor immediately • PEP should begin within 72 hours after exposure to needle stick injury • The closest ICTC should be contacted from where PEP drugs are available

28. NEEDLE STICK INJURY! WHAT SHOULD ONE DO? • PEP means taking antiretroviral medications as soon as possible after injury so that exposure will not result in HIV infection • Treatment should continue for four weeks, if the person can tolerate it • Most cases of needle stick injury by outreach staff are not reported; the PM should routinely enquire in staff meetings

29. CONCLUSION • NSE is the backbone of IDU TI programmes • NSE faces major resistance from the general community; significant efforts must be dedicated to conducting advocacy • NSE serves not only to provide a safe method of injecting, but also as an entry point into the IDU community • Collection of the returned N/S and safe disposal is as important as distribution of N/S “Remember this is a Needle Syringe Exchange Programme, not a mere N/S distribution programme”