Harm reduction in practice - The Community Oriented Substance Use Programme in Tshwane

Area of Science:

• Public Health
• Substance Use Disorders
• Harm Reduction

Background:

• The Community Oriented Substance Use Programme (COSUP) is South Africa's first publicly funded, community-based response to illegal substance use.
• It employs a systems thinking, public health, and clinical care harm reduction approach.

Purpose of the Study:

• To outline the essential components, challenges, and successes of initiating and delivering evidence-based, community-oriented substance use health and care services.

Main Methods:

• The Community Oriented Substance Use Programme (COSUP) is implemented in four Tshwane Metropolitan Municipality regions.
• Quantitative and qualitative data were gathered and triangulated from various program documents.

Main Results:

• COSUP contributed to policy development and established 17 service sites in Tshwane, engaging 169 organizations.
• Services included counseling, care linkage, and opioid substitution therapy for 1513 adults, with significant needle/syringe distribution and capacity building in harm reduction.

Conclusions:

• COSUP presents a feasible, evidence-based, public-health alternative to abstinence-only substance use programs.
• Scaling up requires health system integration, patient-centered care, affordable medications, multisectoral partnerships, capacity development, investment, and political commitment.