Chris Fitch

Rapid assessment, injecting drug use, and public health

We argue that the public-health potential of rapidassessment has yet to be fully realised. We begin bysummarising the key methodological principlesunderpinning rapid assessment. We then draw on recentexamples of the rapid spread of HIV-1 infectionassociated with injecting drug use (IDU) in the newlyindependent states of Eastern Europe to emphasise thatrapidity, methodological pluralism, and an orientationtowards multisectoral intervention are critical features ofeffective public-health assessment and response. Weconclude by proposing that whereas rapid assessmentremains largely peripheral to mainstream public-healthapproaches, it should be given a central role as a generic

Rapid assessment and response: methods for developing public health responses to drug problems

Rapid assessments are used increasingly to assist in the development of public health interventions for drug problems. They have been used to assess drug use and its health consequences, alert governments to the need to intervene, build alliances between community groups and health organisations, identify appropriate interventions (at the individual, community and structural level), indicate obstacles to interventions, test their feasibility and help implement and assess them. Rapid assessment and response (RAR) methods have been developed because: conventional social science and routine drug surveillance information systems often fail to deliver relevant information; many drug problems change faster than social research projects can deliver; and because inappropriate interventions may be developed unless based on good evidence and analysis. Originating as a research method, and often used by international agencies and conducted by external consultants, RAR is a rapidly evolving approach to analysing situ...

Rapid assessment and response studies of injection drug use: knowledge gain, capacity building, and intervention development in a multisite study.

OBJECTIVES We evaluated the World Health Organizations rapid assessment and response (RAR) method of assessing injection drug use and its associated health problems, focusing on knowledge gain, capacity building, and whether RAR leads to the development of interventions reducing the health effects of injection drug use. METHODS Data were derived from RAR studies conducted in Beijing, China; Bogotá, Colombia; Greater Rosario, Argentina; Hanoi, Vietnam; Kharkiv, Ukraine; Minsk, Belarus; Nairobi, Kenya; Penang, Malaysia; St. Petersburg, Russia; and Tehran, Iran. RESULTS Substantial gains in knowledge and response capacity were reported at all of the study sites. Before RAR initiation, prevention and intervention programs had been absent or inadequate at most of the sites. The RARs resulted in many new or modified interventions; 7 sites reported 24 health-related interventions that were subsequently developed and influenced by the RARs. CONCLUSIONS RARs, which require relatively little external funding, appear to be effective in linking assessment to development of appropriate interventions. The present results add to the evidence that rapid assessment is an important public health tool.

Rapid assessment in the drugs field

It has become an axiom of harm reduction approaches, particularly in the context of HIV prevention, that early intervention is critical. Almost a decade ago, (Friedman and Des Jarlais (1991) pointed out that once HIV prevalence among injecting drug users (IDUs) reaches 10%, it can surpass 40-50% prevalence in anything between 1 and 4 years. Recent international reviews also emphasise that one of the critical ingredients underpinning effective public health responses is the ‘rapidity’ with which risk reduction and prevention interventions are implemented (Des Jarlais et al., 1996; Crofts et al., 1998; Strathdee et al., 1998; Rhodes et al., 1999a). Acting quickly to minimise risk in order to prevent harm is a fundamental feature of the logic of the public health movement. A key aspect of rapid response development is assessment. Even if there is apparent global consensus on what constitutes effective HIV prevention and harm reduction, it is in local situations that such global knowledge is applied. Rapid assessment seeks to develop harm reduction responses in cognisance with local conditions. It aims to generate evidence quickly enough in order that interventions can be implemented in time to avert or minimise harms associated with rapidly changing health or social conditions. The concept is a simple one. As noted by Manderson and Aaby (1992a), rapid assessment is an attempt to ‘speed up’ social science research for specific ‘programmatic purposes’. Key features distinguishing rapid assessment from conventional social science research therefore include an emphasis on ‘rapidity’ and ‘intervention relevance’ (Ong et al., 1991; Manderson and Aaby, 1992a; Beebe, 1995). Rapid assessment does not exist for the sake of knowledge generation alone. It generates knowledge purposively. It is action-oriented. It exists in order that interventions can be planned and rapid responses developed.

Origins of an epidemic: the methodological and political emergence of rapid assessment

The recent emergence of rapid assessment as a public health tool in the drug and alcohol field has been a relatively ahistorical process. The lack of such an explicit historical biography is understandable - the findings and impact of rapid assessment have rarely made their way into mainstream journals. However, its continued absence presents the manifest danger of an inward-looking field. This paper describes the development of rapid assessment during the past two decades, with a detailed focus on the emergence of rapid assessment in the drug and alcohol field. This focuses on the central role played by international agencies during the 1980s and 1990s, and the development of rapid methodologies by the World Health Organization to prevent epidemics of HIV among injecting drug users, and the use of rapid methodologies by the United Nations International Drug Control Programme to instruct drug policy reform. The paper also describes key events in other fields including: the emergence of the first formal rapid methodologies in the late 1970s, and the production of the first formal guidelines on conducting rapid assessment during the mid-1980s. The paper concludes by highlighting common challenges that rapid methodologies have faced throughout their history.

Responding to HIV infection associated with drug injecting in Eastern Europe

In some countries in Eastern Europe the spread of HIV infection associated with drug injecting has been rapid. While in several cities in the region HIV prevention programs have been established there remains a need to introduce public health technologies and strengthen existing capacity for rapidly assessing and responding to emerging HIV epidemics. This Harm Reduction Digest describes the spread of HIV among drug injectors in the region existing harm-reduction responses and the application of Rapid Assessment and Response (RAR) as a strategy to further develop these. RAR is a methodology developed by WHO Programme on Substance Abuse to assist in rapidly assessing the individual social and environmental factors related to HIV transmission among intravenous drug users (IDUs) so as to develop appropriate public health responses. The authors of this Digest who have all been centrally involved in this process also describe as an example an HIV prevention training program in the Russian Federation which aims to assist health professionals to respond to the developing crises of HIV/AIDS among IDUs. (authors)