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.