Sandra Hsu Hnin Mon

Session panelists reviewed harm reduction services in 5 country contexts, discussed current challenges, and provided recommendations to improve outreach and service delivery. Key recommendations include increasing resources towards harm reduction services, establishing support systems to empower and engage those seeking services; and incorporating HCV programs into existing harm reduction initiatives.

The shortage of resources and support was a major theme. The Bridge Hope and Health Organization in Afghanistan cited a lack of funding and resources as a key barrier to its harm reduction initiatives. From an operational standpoint, opioid substitution therapy programs in Tajikistan and Myanmar point to increased availability and customized dosage of methadone as crucial to program sustainability. In assessing programmatic structure, most presenters called for increased support services to combat social stigma and empower care-seeking behavior among at-risk PWID. Hepatitis C infection was also a concern. Schatz from Australia and Sibanda from South Africa stressed that the lack of HCV services was highly detrimental to client adherence and retention. An online survey of harm reduction facilities across Europe, Australia, and Canada revealed a notable lack of on-site HCV treatment and management services, with many facilities choosing referrals due to lack of clinical capacity and financial resources.

Harm reduction programs would benefit greatly from prioritizing client retention. This may be done by ensuring uninterrupted continuums of care for health outcomes, such as providing on-site HCV services to reduce dropout risk along the referral pathway. Community or peer support systems provide opportunities for self-representation that could increase interest in the program, resulting in earlier enrollment and continued intervention adherence to interventions. Customized dosage schemes, availability of methadone through conventional health centers, and take-home dosage may prove useful in opioid substitution therapy programs, affording clients a greater sense of control over their health and ultimately a better care experience.