Harm Reduction Services in Mobile Outreach Units

Mobile outreach units play a crucial role in linkage to care. People who inject drugs (PWID) are a vulnerable group and they have reduced access to health care due to multiple barriers. One of the barriers is that health care providers often only focus on single services, rather than on the patient’s overall well-being. By taking a more comprehensive approach and offering help on point of care when needed, integrated care provides a higher quality of care which is more efficient and also makes sure that patient needs are met.

In order to improve harm reduction services, linkage to care, and quality of care, mobile outreach units (busses) will be introduced in Estonia in 2018. These busses will provide harm reduction services (needle exchange, rapid HIV testing, counselling etc.) for PWID in Estonia's capital city Tallinn and surrounding area and the North-Eastern region of the country where injecting drug use is most prevalent. We hope to also be able to provide opioid substitution therapy and other treatment services in the mobile units in future. However, in order to do this several legislative documents need to be amended.

To introduce the mobile outreach units in Estonia, a full day workshop on integrated care was held. The key speakers were Dr Alistair Story PhD FFPH MPH RGN (Clinical Lead and Manager from Find&Treat, University College Hospitals NHS Foundation Trust) and Ruta Kaupe who shared the experiences Latvian has made with mobile outreach units.

The workshop consisted of three sessions each with two to three presentations and discussion time allocated to each topic.

Session topics:

1. Overview of good practices of mobile outreach units from the countries already implementing effective solutions (United Kingdom, Latvia).
2. Overview of service provision: what works best; what are the barriers and how can they be overcome; how can the community be engaged in the process; linkage to other services; and how can the maximum benefit be gained from the mobile outreach units.
3. How to involve service providers in developing mobile outreach unit services for PWID in Estonia (training needs).

45 participants attended the workshop with different key backgrounds:

• Representatives from the Tallinn city government, Ministry of Social Affairs and National Institute for Health Development
• PWID using harm reduction services
• Representatives of NGOs engaged in harm reduction including outreach 
• Healthcare workers
• Pharmacists
• Social workers

The discussions during the workshop led to the following conclusions:

1. Key components of successful service provision are; collaboration between community and service providers; flexibility of service location; and, recognition of wider health and social care needs.
2. Mobile outreach unit services must be linked to stationary health and social services. Working together with the right partners is crucial.
3. All necessary harm reduction and care services should be provided in the point of care, when needed. Mobile services allow us to reach patients who are not able or willing come to the hospitals.
4. Data collection during the service provision is important – it helps to improve the quality of care and meet the clients’ needs.
5. New services must be developed with service users as peer-delivered services have a positive impact on clients’ health.
6. Digital services (mobile outreach unit app) can be useful.