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Learning from a mobile detox pilot in Pakistan Innovation is an important pillar of work for Mainline under the Bridging the Gaps 2 (BtG2) programme. Throughout BtG2, Mainline aims to pilot new interventions; disseminate successful results to other countries, key populations and partners as well as further innovate the harm reduction field. We believe that not all innovations will have their intended effects and that pilots often have outcomes which are different than expected. One example of a learning experience from a pilot intervention is the mobile detox in Pakistan. Great results Mainline has supported its local partner Nai Zindagi in Pakistan with the development of an ARV Adherence Unit (AAU) – an 8 week in-house programme where clients received detoxification, ARV medication and support on management and adherence. The evaluation of the AAU showed great results. AU-graduates reported better adherence rates than non-AAU clients, even when they relapsed into drug use. The mobile detox pilot was a follow-up initiative to give AAU-graduates who relapsed into drug use another possibility to undergo detoxification. The initial idea was to set up a public-private partnership in four cities with a mobile unit to support local clients in one of the four districts. The District AIDS Councils provided the 15 days residential programme spaces, and a mobile medical team of Nai Zindagi moved from district to district once a batch of 10 AAU-graduates was identified and consented for drug treatment. The results were encouraging. 96% of the 283 clients who completed the programme were adherent, which is a 20% increase compared to regular AAU-graduates. However, the realisation of the mobile component turned out to be too complicated and could not continue due to high exploitation costs. Moreover, the demand side exceeded the supply side. As a result, the medical team did not have the time or space to move to the next city. As a result of this pilot, Nai Zindagi established static detox units – instead of mobile units – in order to meet the demand and to provide comprehensive treatment to AAU-graduates. The adaptation of the plans based on the clients’ needs proved to be a valuable learning experience for Mainline and all the partners involved in the project.

Learning from mobile detox april 2017 - BlogBirdmainline-eng.blogbird.nl/uploads/mainline-eng/Learning... · 2017. 5. 2. · Learning from a mobile detox pilot in Pakistan Innovation

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  • LearningfromamobiledetoxpilotinPakistan

    InnovationisanimportantpillarofworkforMainlineundertheBridgingtheGaps2(BtG2)programme.ThroughoutBtG2,Mainlineaimstopilotnewinterventions;disseminatesuccessfulresultstoothercountries,keypopulationsandpartnersaswellasfurtherinnovatetheharmreductionfield.

    Webelievethatnotallinnovationswillhavetheirintendedeffectsandthatpilotsoftenhaveoutcomeswhicharedifferentthanexpected.OneexampleofalearningexperiencefromapilotinterventionisthemobiledetoxinPakistan.

    GreatresultsMainlinehassupporteditslocalpartnerNaiZindagiinPakistanwiththedevelopmentofanARVAdherenceUnit(AAU)–an8weekin-houseprogrammewhereclientsreceiveddetoxification,ARVmedicationandsupportonmanagementandadherence.TheevaluationoftheAAUshowedgreatresults.AU-graduatesreportedbetteradherenceratesthannon-AAUclients,evenwhentheyrelapsedintodruguse.Themobiledetoxpilotwasafollow-upinitiativetogiveAAU-graduateswhorelapsedintodruguseanotherpossibilitytoundergodetoxification.

    Theinitialideawastosetupapublic-privatepartnershipinfourcitieswithamobileunittosupportlocalclientsinoneofthefourdistricts.TheDistrictAIDSCouncils

    providedthe15daysresidentialprogrammespaces,andamobilemedicalteamofNaiZindagimovedfromdistricttodistrictonceabatchof10AAU-graduateswasidentifiedandconsentedfordrugtreatment.

    Theresultswereencouraging.96%ofthe283clientswhocompletedtheprogrammewereadherent,whichisa20%increasecomparedtoregularAAU-graduates.However,therealisationofthemobilecomponentturnedouttobetoo

    complicatedandcouldnotcontinueduetohighexploitationcosts.Moreover,thedemandsideexceededthesupplyside.

    Asaresult,themedicalteamdidnothavethetimeorspacetomovetothenextcity.Asaresultofthispilot,NaiZindagiestablishedstaticdetoxunits–insteadofmobileunits–inordertomeetthedemandandtoprovidecomprehensivetreatmenttoAAU-graduates.Theadaptationoftheplansbasedontheclients’needsprovedtobeavaluablelearningexperienceforMainlineandallthepartnersinvolvedintheproject.


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