摘要：Objectives . We evaluated the World Health Organization’s 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 is a practical public health tool for use in investigating problems in areas in which policymakers, planners, and practitioners need to make decisions in contexts of limited resources and in which conventional social science and public health assessment methods are inappropriate. 1 – 6 Rapid assessments have been used in fields as diverse as nutrition, 5 , 7 reproductive health, water hygiene, 8 environmental disasters, 9 and HIV/AIDS. 10 Some are undertaken to raise awareness of public health problems, whereas others are oriented toward planning, developing, and implementing public health programs and projects. The rapid assessment approach is characterized by speed and the use of multiple methods (including analysis of existing data, key informant interviews, focus groups, observations, mapping, and population estimation) and multiple data sources. Rapid assessment promotes an investigative orientation—involving data triangulation and inductive modes of analysis—and multilevel evaluations of the ways in which health problems are influenced at the individual, community, and structural levels. 10 , 11 The method is designed to ensure that responses are strengthened through community involvement. Rapid assessments are widely used in investigating drug problems. 12 – 16 Rapid assessment guidelines for substance use 17 have been issued by the World Health Organization (WHO), the Joint United Nations Programme on HIV/AIDS, the United Nations Children’s Fund, the United Nations International Drug Control Programme, 18 , 19 the US Office of HIV/AIDS Policy, Médecins Sans Frontières of Holland (MSF-H), the United Nations Development Programme, and the International HIV/AIDS Alliance. Most rapid assessment guides and reports remain in the unpublished literature. 17 In 1998, the WHO rapid assessment initiatives were relabeled rapid assessment and response (RAR) to highlight the link between the assessment of and the development of health-related interventions. The emphasis is not on knowledge gain per se but on how knowledge is used in improving public health responses. Thus, along with guidance on assessment methods, the WHO RAR guides include information on community participation, capacity building, advocacy, methods of formulating recommendations, and ways to develop and plan interventions. They also include basic information on prevention, harm reduction, and treatment interventions. 20 – 22 RARs on injection drug use (IDU) typically involve profiling the study area and the context of IDU in that area and then assessing the populations and settings at risk, drug use patterns and health risk behaviors, health and social issues linked to IDU, and interventions currently available. These RARs typically result in action plans involving recommendations for new or modified interventions. A recent review showed that at least 83 rapid assessment studies on substance use, involving 322 different sites in 70 countries, were undertaken in the period 1993 through 2001. 23 The largest study—conducted in the Russian Federation—involved the MSF-H program focusing on HIV/AIDS prevention among injection drug users; in this program, 200 health professionals from 61 cities underwent training in rapid assessment and HIV prevention, resulting in 63 rapid assessments. 24 Another multisite RAR was the US Rapid Assessment, Rapid Response, and Evaluation (RARE) study, which focused on HIV/AIDS in African American and Hispanic communities. 25 The proliferation of rapid assessment work in the substance use field 26 , 27 has not been matched by evaluations of the method, 28 – 30 and there has been considerable debate about evaluation criteria. 30 – 35 In our view, it is necessary to judge the RAR approach in terms of both methodological adequacy and whether the approach leads to relevant public health interventions. We chose to focus on the latter issue, undertaking a prospective evaluation of RAR studies on IDU as part of the WHO Phase II Drug Injection Study.
