Drug consumption rooms (DCRs) as a setting to address hepatitis C – findings from an international online survey

Abstract

BackgroundPrevalence of Hepatitis C Virus (HCV) among people who inject drugs (PWID) is high. Risky injecting behaviours have been found to decrease in drug consumption rooms (DCRs) and supervised injecting facilities (SIFs), yet HCV prevention and treatment in these settings have not been extensively explored.MethodsTo determine the range and scope of HCV prevention and treatment options in these services, we assessed DCR/SIF operational features, their clients’ characteristics and the HCV-related services they provide. A comprehensive online survey was sent to the managers of the 91 DCRs/SIFs that were operating globally as of September 2016. A descriptive cross-country analysis of the main DCR/SIF characteristics was conducted and bivariate logistic models were used to assess factors associated with enhanced HCV service provision.ResultsForty-nine valid responses were retrieved from DCRs/SIFs in all countries where they were established at the time of the survey (Australia, Canada, Denmark, France, Germany, Luxembourg, Netherlands, Norway, Spain and Switzerland). Internationally, the operational capacities of DCRs/SIFs varied in terms of funding, location, size and staffing, but their clients all shared common features of vulnerability and marginalisation. Estimated HCV prevalence rates were around 60%. Among a range of health and social services and referrals to other programs, most DCRs/SIFs provided HCV testing onsite (65%) and/or offered liver monitoring or disease management (54%). HCV treatment onsite was offered or was planned to be offered by 21% of DCRs/SIFs. HCV testing onsite was associated with provision of other services addressing blood-borne diseases and HCV treatment was linked to the provision of OST. HCV disease management was associated with employing a nurse at a DCR/SIF and HCV treatment was associated with employing a medical doctor.ConclusionsDCRs/SIFs offer easy-to-access HCV-related services for PWID. The availability of onsite medical professionals and provision of support and education to non-medical staff are key to enhanced provision of HCV-related services in DCRs/SIFs. Funding and support for HCV treatment at the community level, via low-threshold services such as DCRs/SIFs, are worthy of action.

Perspectives on HIV pre-exposure prophylaxis (PrEP) utilization and related intervention needs among people who inject drugs

“…Additionally, because many PWID experienced structural barriers to PrEP use (e.g., homelessness, poverty) and desire simplified PrEP access processes, PrEP could also be delivered through more accessible and trusted settings, such as NSPs and other CBOs (e.g., drop-in HIV/HCV testing centers), as suggested by participants and key informants in our study. Indeed, HCV treatment, which also requires testing and screening processes and daily adherence to medication, has been successfully delivered through drug treatment (e.g., methadone) services [ 59 , 60 ] and could possibly be delivered through other community-based harm reduction venues (e.g., supervised injection facilities or drug consumption rooms in settings where those services are available) [ 61 ]. Through these organizations, PrEP prescribers could provide or make referrals to other essential health services.…”

Supervised injection facility use and all-cause mortality among people who inject drugs in Vancouver, Canada: A cohort study

“…Within SIFs, clients are typically provided with sterile drug use equipment, education on safer drug consumption practices, emergency intervention in the event of overdose, and referrals to co-located and external addiction treatment and health services [11]. At present, more than 140 SIFs are in operation internationally, including in Canada, Australia, and Europe [10–15].…”

Drug consumption rooms: A systematic review of evaluation methodologies

“…In 2016, 92 DCRs/SIFs across 11 countries were in operation, with the majority located in Germany, Netherlands and Switzerland, several in Spain, Denmark, Norway and France and, until recently, one each operating in Australia, Canada and Luxembourg . The opening of SIFs in Portugal is scheduled for 2018–2019 and is under discussion in Ireland, Scotland and in USA .…”