Research Initiatives on Appropriate Community Based Peer Approaches for Harm Reduction among Drug Users in Senegal

Injecting drug use is emerging as a human rights and development challenge in Sub-Saharan Africa. People Who Inject Drugs in countries like Senegal are vulnerable to a range of health and social harms, in particular HIV. Whilst treatments for HIV can be made available, they are often difficult to access: people who inject drugs are poor, highly marginalised and lack social support, in addition to often having other pre-existing health issues, such as poor mental health. Community level support in the form of 'outreach' - literally taking services and support to where highly marginalised people live - has been shown to increase access to much needed care. Outreach to support people who inject drugs is being introduced in Senegal; this is a key opportunity to develop innovative models of outreach that respond to the unique contexts of a low income setting, with potential benefit across the region. This research project brings together experts in Senegal and from the UK to support the development of new forms of outreach. When the study is completed in 2016 we aim to have supported a form of outreach that responds to the specific needs of people in Senegal, and that can be tailored to other countries in the region facing similar challenges.

Our aim is to develop a model of community change outreach (CCO) to support combined HIV prevention and treatment for People Who Inject Drugs (PWID) in Senegal, a country experiencing a fast growing HIV epidemic linked to drug injecting.

The injection of drugs like heroin and cocaine is now a major health and social challenge for the West Africa region. Effective harm reduction interventions are largely absent for this population, while access to HIV services is limited. Global evidence supports the combination of HIV prevention and treatment interventions such as needle and syringe programmes, opioid substitution therapy, HIV testing and antiretroviral treatment as effective for this population; linked outreach interventions aim to reach PWID directly in the community to provide these services in situ and foster linkages in to combination care. Outreach with PWID is widely used but there is an absence of evidence regarding its development and implementation in West Africa. There is therefore an urgent need to develop outreach models that are feasible, acceptable, effective and scalable in the West African context.

We will work in collaboration between the London School of Hygiene and Tropical Medicine (LSHTM), the Senegalese Alliance Nationale Contre le SIDA (National Alliance to Control AIDS, ANCS) and Universite Cheikh Anta Diop (UCAD) to undertake a sequence of research activities to develop the intervention and design of a future impact evaluation: i) an ethnographic assessment to assess needs and social context; ii) operational research of the emerging intervention, including qualitative interviews and a respondent driven survey of PWID; iii) exploration of the feasibility of methods for a future impact evaluation. The study outputs will be a model of CCO adapted to the aims and context of Senegal, linked with a design for future impact evaluation.