CURE & CARE 1 MALAYSIA CLINIC

Transcription

1 CURE & CARE 1 MALAYSIA CLINIC TOWARDS AN INTEGRATED TREATMENT AND REHABILITATION FOR PEOPLE WHO USE DRUGS By : DR.SANGEETH KAUR NATIONAL ANTIDRUGS AGENCY MINISTRY OF HOME AFFAIRS

2 BACKGROUND The Cure & Care 1Malaysia Clinic was officially launched on 1 st July 2010 at the Anti-Narcotics Rehabilitation Centre in Sungai Besi, Kuala Lumpur. This clinic provides open access services to drug abusers, drug users, their families, employers and individuals with drug problems.

3 Inpatient Seven components of the client s placement services are : Outpatient Medical detoxification Day care Short term services Drug substitution therapy Referral and advocacy

4 CORE SERVICES 4 main core services are provided for clients:- Registration Evaluation Placement Intervention Program

5 A client can have access to these services through: 1 Walk-in 2 Referral by family, employers or hospitals 3 Outreach by NADA officers or NGO s

6 3 principles of the services provided:- Voluntarism (Confidential) Non- conditional No legal implications

7 TREATMENT PROCESS DISCHARGED COMPLETED DISMISSED DROP-OUT PROGRAMS INPATIENT OR OUTPATIENT ADMISSION PHYSICAL, MEDICAL & PSYCHIATRIC CLINICAL ASSESSMENT A.S.S.I.S.T U.R.I.C.A PSYCHOSOCIAL ASSESSMENT

8 Guidance and counseling TEXT Religious and spiritual education Relapse prevention Community Service Re-entryContinued supervision and Aftercare SERVICES PROVIDED The Cure & Care 1Malaysia Clinic provides a broad range of services such as : Pre & Post HIV Testing (vct) Saringan TB/Hep B/Hep C Clinical and psychiatric evaluation MMT Psychiatric Management Medical Detoxification Dental TEXT Alcohol Withdrawal Management Health Education Hep B Vaccine INH prophylaxis for latent TB OPD TEXT Referral and advocacy Vocational skills, education and training Job placement Support groups (family, employers etc) TEXT ARV

9 C & C 1 MALAYSIA CLINIC

10 REGISTRATION

11 PSYCHOSOCIAL EVALUATION

12 CURE & CARE 1 MALAYSIA CLINIC SG. BESI Registration at Clinic OPD

13 Outpatient treatment by Medical Assistant CURE & CARE 1 MALAYSIA CLINICSG. BESI

14 CURE & CARE 1 MALAYSIA CLINIC SG. BESI Medical Detoxification Ward

15 CURE & CARE 1CLINIC MALAYSIA SG. BESI Daily Observation and Withdrawal Chart Monitoring

16 CURE & CARE 1 MALAYSIA CLINIC SG. BESI Early Intervention by councilor

17 Medication dispensed by pharmacist (DOT) KLINIK CURE & CARE 1 MALAYSIA SG. BESI

18 KLINIK CURE & CARE 1 MALAYSIA SG. BESI Methadone Patients awaiting dosing

19 DOT METHADONE BY PHARMACIST

20 MEDICAL EVALUATION BY MEDICAL OFFICER

21 ACHIEVEMENTS Since its launch on 1 st July 2010 the C & C 1Malaysia Clinic has received commendable response. As of October 2010, 9000 clients have visited and received various services at the C & C 1Malaysia Clinic. Currently there are 900 clients registered in the Methadone Maintenance Therapy at Clinic C&Cs and 1400 clients registered at Cure and Care Service Centres Voluntary based HIV screening is conducted Mental Health screening conducted and seen by psychiatrist.

22 STATISTICS No. Accumulative Clients at Cure & Care Clinics No of Clients and Drug of Choice

23 No of Clinic Visits Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11

24 HIV Screening No of Test No HIV positive Oct'10 Nov'10 Dec'10 Jan'11 Feb'11 Mac'11 Apr'11 May'11 Jun'11 Jul'11 Aug'11 Sept'11 No of patients started on ARV No of patients started on ARV Oct'10 Oct'10 Nov'10 Nov'10 Dec'10 Dec'10 Jan'11 Jan'11 Feb'11 Feb'11 Mac'11 Mac'11 Apr'11 May'11 Jun'11 Jul'11 Aug'11 Aug'11 Sept'11 Sept'11

25 National HIV Notification among IVDU percentage of notified HIV cases through injecting drug has decreased from 66% in 2005 to 47.6% in 2010 Percentage Drug Abuse Statistic, Malaysia, Year Opiate Stimulan Marijuana Others Percentage of Notified HIV Cases by Risk Factor, Malaysia, IVDU YEAR Opiate addiction has shown decreasing trend, from 67% in 2005 to 50% in Source : MoH Malaysia

26 INFECTIOUS DISEASES SCREENING CLIENTS OCT 10 NOV 10 DEC 10 JAN 11 FEB 11 MAR 11 MONTHS APR 11 MAY JUNE JULY 11 AUG 11 SEPT 11 HIV HEP B HEPC TIBI

27 Psychiatric Cases at C&C Clinic Sg. Besi Depression, 8% Others, 3% Organic Disorder, 15% Drug Induced Psychosis, 74% Retention rates of psychiatric cases in treatment after 1 year is 67%

28 METHADONE MAINTENANCE THERAPY CCSC CCSC 24 KLINIK C&C 2 CCSC CCSC CCSC 33 CCRC 2 C&C CLINIC 8

29 MMT ACHIEVEMENTS AT NADA CCSC 11 PUSPEN 0 C&C 0 CLINIC TOTAL 11 CCSC 184 PUSPEN 0 C&C 0 CLINIC TOTAL 184 CCSC 689 PUSPEN 0 C&C 0 CLINIC TOTAL 689 CCSC 1024 PUSPEN 0 Klinik 0 C&C TOTAL 1024 CCSC 1379 PUSPEN 21 C&C 900 CLINIC TOTAL 2300 Example text

30 MMT ACHEIVEMENTS AT NADA OVERALL DATA 2011 MMT WAS EXPANDED TO; 33 CCSC 8 C&C 1Malaysia Clinics 2 PUSPEN Target Clients No. Registered Clients 1183 (89.3%) 2300 No of Active Clients No of Non Compliant Clients Klien yang bekerja 632 1,330 EMPLOYMENT No of clients that have started working after enrolling in the program has increased to 1330 klien (67.7%) pada tahun 2011 from 632 (53%) clients in 2010

31 MMT ACHIEVEMENTS AT NADA Graph 1 : Retention Rate of outpatient MMT clients at C&C Clinics (KLINIK C&C) Retention Rate of MMT Clients at C&C Clinics mths 6 mths 9 mths 12 mths Graph 2: Retention Rate in Comparison to WHO Standard RETENTION RATE IN COMPARISON TO WHO STANDARDS NADA WHO mths 6 mths 9 mths 12 mths

32 CLIENTS TOTAL NO. REGISTERED METHADONE CLIENTS OCT 10 NOV 10 DEC 10 JAN 11 FEB 11 MAR 11 APR 11 MAY 11 JUNE 11 JULY 11 AUG 11 SEPT 11 MONTHS REGISTERED ACTIVE % 40% 30% 20% 10% 0% PERCENTAGE OF URINE POSITIVE METHADONE CLIENTS (OUTPATIENT) OCT 10 23% NOV 10 16% DEC 10 33% JAN 11 11% 9% FEB 11 MAR 11 25% APR 11 20% MAY 11 25% JUNE 11 21% JULY 11 12% AUG 11 28% 24% SEPT 11

33 Employment of MMT Clients KLINIK CURE Employment & CARE 1MALAYSIA (KLINIK C&C) 19% 2% 3% 5% 17% 22% 32% Security Guards Own Business The programme has achieved in reducing unemployment among people who use drugs by providing training and employment opportunities. 151 (84.8%) of the MMT clients have started work after joining the programme. Driver Contractor Catering Unemployed Others

34 FUTURE TREATMENT PROGRAMMES TO BE INTRODUCED 1 Introduction of Suboxone for HIV clients on ARV 2 Suboxone as an option for Medical Detoxification 3 INH Prophylaxis for Latent TB for HIV Clients 4 Occupation Therapy to be a part of Rehabilitation 5 Cognitive Remediation Therapy 6 Specialised Programme for Inhalan Abuse among youth

35 RECOMMENDATIONS Skills training to be provided by Ministry of Health, Ministry of Women, Welfare Department and Universities. Medical leave of employees undergoing treatment. To provide more doctors and psychiatrists in this clinic to ensure continous medical care and mental health care of clients.

36 CONCLUSION With the transformation in the approach to drug treatment and rehabilitation and the setting up of the Cure & Care 1Malaysia Clinics, NADA has aligned itself as one of the best practices/ evidence-based practice in treatment and health care of drug users.

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