Hepatitis C services at harm reduction centres in the European Union: a 28-country survey

Abstract

BackgroundIn the context of the WHO’s 2016 Viral Hepatitis Strategy and the introduction of treatment that can cure more than 95% of cases with hepatitis C virus (HCV) infection, the European Joint Action on HIV and Co-infection Prevention and Harm Reduction (HA-REACT) undertook a study in the member states of the European Union (EU). It aimed to determine service providers’ understanding of the current services in their respective countries and the barriers experienced by PWID in accessing HCV testing, care and treatment services in their country.MethodsIn 2017, 38 purposively selected harm reduction service providers completed a 26-item English-language online survey addressing the availability, accessibility and funding of HCV services at harm reduction centres. HCV-related data and reported findings were extracted by country or by responding organization.ResultsResponses were received from all EU member states. Respondents from 23 countries reported that HCV tests are offered by harm reduction services in their countries, and eight countries reported that addiction specialists in their countries are able to prescribe HCV therapy. Almost half of the respondents (45%) said that their respective organizations had established referral systems with centres providing HCV treatment.ConclusionsNot all EU member states have harm reduction services that provide HCV tests, and many do not have established referral systems with treatment providers. Moreover, the inability of addiction specialists to prescribe HCV treatment points to missed opportunities to make treatment more accessible. Further, discrepancies were noted between the available HCV services and stakeholders’ knowledge about their availability.

Exploring how Hospitalization Can Alter Hepatitis C Virus Treatment Prioritization and Trajectories in People who Use Drugs: A Qualitative Analysis

“…In order to reduce HCV transmission rates and as a key component of “treatment as prevention” efforts, we need effective outreach programs to motivate and engage those in the “HCV treatment non-engaged” trajectory 7 , 8 . Potential avenues to increase HCV treatment access to “non-engaged” participants may include bringing care more directly to them by incorporating HCV treatment into existing harm reduction programs and to housing services and shelters 38 – 41 . Interventions for closing gaps in the HIV care continuum for patients actively using substances might inform programs to better engage hospitalized PWUD in HCV treatment 42 …”

“…7,8 Potential avenues to increase HCV treatment access to "non-engaged" participants may include bringing care more directly to them by incorporating HCV treatment into existing harm reduction programs and to housing services and shelters. [38][39][40][41] Interventions for closing gaps in the HIV care continuum for patients actively using substances might inform programs to better engage hospitalized PWUD in HCV treatment. 42 We describe how for many PWUD, hospitalization and engagement in addiction treatment may affect HCV treatment prioritization-with participants expressing desire for HCV cure urgently or in the future.…”

Programa de certificación de Centros de Adicciones para la eliminación del virus de la hepatitis C en España. Proyecto HepCelentes

“…En los últimos años, se han realizado avances importantes en el manejo de los usuarios de los centros de adicciones con hepatitis C, pero todavía existen una serie de barreras de acceso y faltan herramientas estructuradas, consensuadas y avaladas por expertos, que acrediten el funcionamiento correcto de los programas y estrategias orientadas a la reducción de la infección por el VHC y a la disminución de las necesidades no cubiertas en este colectivo (Corma-Gómez y Pineda, 2019; Pericàs et al, 2019).…”

Barriers to access to hepatitis C treatment with direct-acting antivirals in people who inject drugs in the community setting. A qualitative study with prison population.

“…Speci cally, detection has been strengthened from harm reduction services in Catalonia, included within care for drug dependencies. These services offer needle exchange programmes (NEP), drug consumption rooms (DCR) and health and social care, to which PWID who present social and health di culties attend to access diagnosis and treatment in other health care services or through ordinary circuits 15,16 . Recent studies carried out in Catalonia highlight that around 35% of PWID present hidden infection, with a higher percentage among migrants 11,13 .…”