Changes to the national strategies, plans and guidelines for the treatment of hepatitis C in people who inject drugs between 2013 and 2016: a cross-sectional survey of 34 European countries

Abstract

Background Hepatitis C virus (HCV) infection is the leading cause of cirrhosis, end-stage liver disease and hepatocellular carcinoma (HCC) worldwide. In Europe, people who inject drugs (PWID) represent the majority of HCV infections, but are often excluded from treatment. The aim of this study was to report on national HCV strategies, action plans and guidelines in European countries that include HCV treatment for the general population as well as for PWID. Data on access to direct-acting antivirals (DAAs) were also collected. Methods In 2016, 38 non-governmental organisations, universities and public health institutions that work with PWID in 34 European countries were invited to complete a 16-item online survey about current national HCV treatment policies and guidelines. Data from 2016 were compared to those from 2013 for 33 European countries, and time trends are presented. Differences in the data were analysed. Data from 2016 on general access to DAAs in PWID are presented separately. Results The response rate was 100%. Fourteen countries (42%) reported having a national HCV strategy covering HCV treatment; 12 of these addressed HCV treatment for PWID. Respondents from ten countries (29%) reported having a national HCV action plan. PWID were specifically included in seven of them. Twenty-nine countries (85%) reported having national HCV treatment guidelines. PWID were specifically included in 23 (79%) of them. Compared to 2013, respondents reported that an additional seven countries (25%) had national strategies, an additional eight countries (29%) had action plans and an additional six countries (19%) had HCV treatment guidelines. However, PWID were not included in two, four and six of those countries, respectively. DAAs were reported to be available in 91% of the study countries, with restrictions reported in 71% of them. Conclusion Respondents reported that fewer than half of the European countries in this study had a national HCV strategy and/or action plan, with even fewer including PWID. However, when compared to 2013, the number of such countries had slightly increased. Although PWID are often addressed in clinical guidelines, strategic action is needed to increase access to HCV treatment for this group and the situation should be regularly monitored. Electronic supplementary material The online version of this article (10.1186/s12954-019-0303-9) contains supplementary material, which is available to authorized users.

We know DAAs work, so now what? Simplifying models of care to enhance the hepatitis C cascade

“…Other obstacles also need to be overcome to scale‐up HCV treatment . They include the heterogeneity of national policies , a lack of appropriate infrastructure for HCV services in tertiary centres and addiction clinics , stigma and discrimination (including the reluctance of some physicians to treat PWID , limited access to point‐of‐care diagnostics , and inadequate knowledge of HCV and HCV treatment and a generally deficient sense of urgency .…”

Elimination of hepatitis C in Europe: can WHO targets be achieved?

“…Compared with never-injectors, treatment with DAAs works well in PWID and evidence already exists that broad accessibility to DAAs can lower the prevalence of HCV RNA among PWID [43,44]. In many countries an unrestricted access to DAAs for PWID has not yet been granted, and in some countries PWID are still excluded from treatment guidelines [30,45]. Engagement of all the stakeholders, including harm-reduction services, the community and the affected population, is needed to overcome those barriers [29].…”

The civil society monitoring of hepatitis C response related to the WHO 2030 elimination goals in 35 European countries

“…A majority of them lacks access to harm reduction services, in spite of evidence-based recommendations from WHO, the European Association for the Study of the Liver (EASL) [12] as well as other professional associations to assure PWID's access to HCV testing and care as a matter of priority for individual as well as public health. The availability of hepatitis care varies substantially among countries and often remains below WHO targets, with globally less than 1% of PWID living in countries with access to both, HCV testing and treatment [13][14][15]. Moreover, even where the services exist, PWID face many difficulties in accessing a continuum of care for hepatitis C that includes prevention, testing, linkage-tocare, and treatment and are often excluded from treatment by restrictive guidelines, have poor access to health services, and are likely to experience stigmatization when discussing/disclosing drug use practices [15].…”