Low threshold services
THE TERM “LOW-THRESHOLD” IS USED TO DESCRIBE A SETTING WHICH AIMS TO FACILITATE ACCESS BY PEOPLE WHO USE DRUGS TO SOCIAL AND HEALTH SERVICES, THAT TYPICALLY INCLUDES OUTREACH TEAMS, STREET UNITS, NEEDLE-EXCHANGE POINTS, DROP-IN OR CONTACT CENTERS, NIGHT SHELTERS, SUBSTITUTION TREATMENT PROGRAMS, ETC.
To lower the threshold of access, such agencies choose specific locations and opening hours, require little bureaucracy, often no payment, no need to have official documents and are not linked to an obligation of the client to be or to become drug-free. They target people who are currently using drugs, “hard-to-reach” groups, high-risk groups among drug users and experimental users. Therefore, implementation of HIV/HCV testing in a low threshold center could represent an important strategy to increase the uptake of HIV/HCV testing for those populations with poorer access to traditional health care.
The implementation of testing programs in low-threshold services requires the involvement of different professionals, each of them with a specific role: outreach/social workers for approaching, informing and motivating the target group to be tested; psychologists/counsellors/social workers for providing pre- and post-counselling; doctors/nurses for administering the rapid test. This definition of roles is important for ensuring the good quality of the provided services and facilitating collaboration and teamwork. Volunteers can be also involved in these kind of programs, but it is fundamental that they receive specific training on drug use and related infectious diseases, in order to get a comprehensive knowledge of the topic and have a better work performance.
In these settings particularly important are approaching and recruitment of clients, in order to make their work more effective and valuable. It is always recommended to be flexible and ready to adapt the work to particular needs, situations and circumstances, so that the pre- and post-counselling will not be left out or minimized. In fact, it is not always easy to follow the indicated procedure step-by-step, due to the specific characteristics of the clients of this kind of services. For example, the distribution of informative leaflets should be accompanied or replaced by the verbal explanation of the aim and procedures of testing, because a high percentage of clients approached rarely read the leaflets; for clients who are in a hurry and don’t want to waste much time, it might be necessary to speed up the procedure.