Needle exchange: an NTA perspective

1
Needle exchange an NTA perspective

• 1 July 2009
• Hugo Luck

2
Why NEX?

• Its effective
• It links us to treatment naïve/resistant
  populations
• A cornerstone of harm reduction, the leading
  public health response to drug use.

3
The current national picture

• Sharing down to about 25 of users, though still
  above the mid-1990s.
• Groin and crack injecting more common, have
  become more common.
• One third of injecting drug users reporting
  injecting site infection in the last year.
• Overall almost half of injecting drug users are
  now infected with HCV and about one in 90 with
  HIV.
• There has been a marked increase in the number of
  injecting drug users receiving the hepatitis B
  vaccine, with two-thirds now reporting
  vaccination (how much of this is prison?).
• Source Shooting Up 2008

4
NEXMS

• Sorry
• The software has been fixed
• All is not lost

5
In the meantime

• The quality of the data we do have seems quite
  good
• For those DATs who have submitted data well be
  producing an initial report as part of the Needs
  Assessment
• Were planning to open the system for an
  amnesty to submit previously unreported data.

6
For Example
Data are not currently public domain
7
Planning, needs assessment and communityengagemen
t

• Use the existing process
• BUT may need new sources of data
• What are your links with public health?
• Are the Local Authority on board?

8
2) Meeting need

• Tie directly to needs assessment
• Economies of scale for disposal
• Formal and informal needle identification
• ICPS for all relevant services what are the
  gaps and how to fill them
• Auditing and monitoring How much do we need to
  know?

9
3) Types of service

• What does balance look like?
• All Specialist Treatment services managing
  using on top
• Accessibility vs. cost efficiency

10
4) Equipment and advice

• No limits what challenges will this present?
• Flexibility of disposal/sharps bins
• Who decides the advice and information given?
• Talking to users
• Encouraging/nagging/facilitating

11
5) Community pharmacy-based NSPs

• What additional services can pharmacy offer?
• Is it an appropriate setting?
• Confidentiality

12
6) Specialist NSPs

• Staff competency
• Wound care
• Referral services on site and off site

13
More needed

• Are you NICE compliant?
• What isnt covered by NICE?
• Do we have enough information?
• Does NEX fit well with existing treatment systems?

14
The role of the NTA

• Built into existing treatment planning/performance
  management mechanisms
• Regional teams to work with commissioners and
  providers to ensure guidelines understood and
  implementation process agreed
• Links to the Harm reduction works campaign
• Disseminate good practice
• Get NEXMS right (and use it)

15
More information

• www.nice.org.uk
• www.nta.nhs.uk
• www.harmreductionworks.org.uk