title: Scale-up of a comprehensive harm reduction programme for people injecting opioids: lessons from north-eastern India.
abstract: OBJECTIVE
  Harm reduction packages for people who inject illicit drugs, including those infected with human immunodeficiency virus (HIV), are cost-effective but have not been scaled up globally. In the north-eastern Indian states of Manipur and Nagaland, the epidemic of HIV infection is driven by the injection of illicit drugs, especially opioids. These states needed to scale up harm reduction programmes but faced difficulty doing so.
  
  
  METHODS
  In 2004, the Bill & Melinda Gates Foundation funded Project ORCHID to scale up a harm reduction programme in Manipur and Nagaland.
  
  
  METHODS
  In 2003, an estimated 10 000 and 16 000 people were injecting drugs in Manipur and Nagaland, respectively. The prevalence of HIV infection among people injecting drugs was 24.5% in Manipur and 8.4% in Nagaland.
  
  
  RESULTS
  By 2012, the harm reduction programme had been scaled up to an average of 9011 monthly contacts outside clinics (80% of target); an average of 1709 monthly clinic visits (15% of target, well above the 5% monthly goal) and an average monthly distribution of needles and syringes of 16 each per programme participant. Opioid agonist maintenance treatment coverage was 13.7% and retention 6 months after enrolment was 63%. Antiretroviral treatment coverage for HIV-positive participants was 81%.
  
  
  CONCLUSIONS
  A harm reduction model consisting of community-owned, locally relevant innovations and business approaches can result in good harm reduction programme scale-up and influence harm reduction policy. Project ORCHID has influenced national harm reduction policy in India and contributed to the development of harm reduction guidelines.
authors.affiliation: Project ORCHID, Emmanuel Hospital Association, Guwahati, India.
authors.forename: Melody
authors.initials: M
authors.lastname: Lalmuanpuii
authors.forename: Langkham
authors.initials: L
authors.lastname: Biangtung
authors.forename: Ritu Kumar
authors.initials: RK
authors.lastname: Mishra
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Reeve
authors.forename: Sentimoa
authors.initials: S
authors.lastname: Tzudier
authors.forename: Angom L
authors.initials: AL
authors.lastname: Singh
authors.forename: Rebecca
authors.initials: R
authors.lastname: Sinate
authors.forename: Sema K
authors.initials: SK
authors.lastname: Sgaier
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D003153:Community Health Services / Q000191:economics / Q000458:organization & administration*; D003256:Community Participation; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology; D040261:Harm Reduction; D006801:Humans; D007194:India / Q000453:epidemiology; D009270:Naloxone / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000627:therapeutic use; D009293:Opioid-Related Disorders / Q000453:epidemiology* / Q000628:therapy; D015995:Prevalence; D060386:Sex Workers; D015819:Substance Abuse, Intravenous / Q000188:drug therapy / Q000453:epidemiology*
chemical_list: D044966:Anti-Retroviral Agents; D009292:Narcotic Antagonists; D009270:Naloxone