Mohammad Shoriful Alam (MPH), native of Bangladesh working around twenty years as an activist in the area of HIV Intervention program among PWID and PLHIV.

Issue:
Traditionally, HIV prevention services for People Who Use Drugs (PUD) in Bangladesh were delivered through drop-in centers (DICs) funded primarily by the Global Fund (GF) through Save the Children. These centers, external to public health facilities, addressed PUD needs in a culturally sensitive manner. Recently, a strategic shift occurred, relocating DICs into public hospitals, supplemented with capacity-building, resources, and supervision from the GF.

Setting:
Under the GF project (July2022-June2024), 13 out of 40 DICs were relocated into government hospitals.

Project:
Relocation process involved multiple stages: “selecting hospitals” based on various criteria, coordinating with government's authority named AIDS/STD Program for approvals, allocating space through formal requests, renovating spaces with GF grants, and developing a comprehensive management plan. This plan, created collaboratively with multiple stakeholders, included mechanisms for monitoring and coordination. Additionally, extensive training and orientation were provided to service providers and PUD for their readiness. Network of PUD were engaged in the whole process.

Outcome:
•Hospital-based service delivery result in a 28% increase in general health service recipients in 2023-24, compared to the DIC model in 2022-23.
•Notable reduction in stigma/discrimination towards PUD, with 2,420 PUD got access to free medication which was rare before integration.
•Hospitals managed 248 complicated STI and 295 abscess cases with necessary medication, previously unaddressed in the DIC model.
•Monthly operational (house rent, electricity, water, medical waste disposal, guard, etc.) cost savings of approximately $800 per DIC were realized.
•Mutual support between hospital authorities and NGO staff was established for efficient service delivery.

While challenges remain in fully integrating PUD into the public health system, the transition from NGO-led to government-operated services is underway and shows promise for sustainability. Future efforts will focus on enhancing full readiness among PUD and service providers to ensure seamless integration of HIV prevention services into the public health infrastructure.