HIV and HCV rapid testing in low threshold settings for PWUD
This course has been designed to be a complete tool to provide staff in low-threshold settings the knowledge, skills and techniques needed for testing people who use drugs for HIV and HCV and linking them to needed care. It was developed within the EU-funded programme, Joint Action on HIV, Viral Hepatitis and Tuberculosis among People Who Inject Drugs in Europe (HA-REACT).
Main topics:
- Basic information about HIV, HCV, and TB
- What types of HIV and HCV tests exists and how they work
- The standards of test counselling
- Understanding philosophy of harm reduction
- Addressing gender issues within existing services and developing gender-specific services
- Integrated approaches in relation to substance use and HIV/HCV testing
- What can be done to support linkage
- How to choose the right tools and understand the meaning of quality
- Standards for HIV and HCV testing in prison settings
In this module you will learn:
- The biology of HIV and HCV;
- Modes of transmission of HIV and HCV;
- Screening and diagnosis methods for HIV and HCV;
- HIV and HCV treatment options;
- Basic information about tuberculosis.
The biology of HIV
HIV stands for ‘human immunodeficiency virus’ that causes AIDS. Immunodeficiency means decrease or weakness in the body’s ability to fight off infections and illnesses.
See more... Published: 2022
The biology of the Hepatitis C virus (HCV)
The Hepatitis C virus (HCV). Viral hepatitis C is a liver disease caused by the hepatitis C virus (HCV) which attacks liver cells and replicates inside them leading to changes in liver cells and malfunctions.
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HIV transmission
HIV is transmitted via blood during sexual intercourse with an infected partner or by contact with infected blood, most often by sharing of needles, syringes or other paraphernalia contaminated with the virus. It is also possible to get the infection by transfusion with HIV-infected blood.
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HCV transmission
The hepatitis C virus is a blood-borne virus. It is most commonly transmitted through exposure to small quantities of blood.
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Screening and diagnosis for HIV
Screening and diagnosis of HCV
Because acute HCV infection is usually asymptomatic, few people are diagnosed during the acute phase. In those people who go on to develop chronic HCV infection, the infection often remains undiagnosed because it often remains asymptomatic until symptoms develop secondary to serious liver damage.
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HIV treatement and drug use
WHO guidelines recommend initiation of antiretroviral therapy (ART) regardless of CD4 count for all people living with HIV, including people who use drugs. ART should be started as soon as possible after the diagnosis.
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Treatment for HCV
Antiviral medicines can cure more than 95% of persons with hepatitis C infection, thereby reducing the risk of death from liver cancer and cirrhosis. There is currently no vaccine for hepatitis C.
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Tuberculosis
Tuberculosis (TB) is an infectious disease that, unlike HIV and hepatitis, is caused not by viruses but bacteria.
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HIV, HCV, TB - additional resources
By the end of the session participants will understand:
- What types of HIV and HCV tests exists
- How they work, and
- What the ‘window period’ is.
Antibody screening test
Practically all people living with HIV and/or HCV have antibodies to the respective viruses. Antibodies usually develop during the first month of infection but it can take a longer time before tests can detect them.
See more... Published: 2022
Rapid Test
Rapid, point-of-care tests make it easier for people to access testing and ensure that test results are received and are acted upon immediately.
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Follow-up diagnostic test for HIV
All reactive primary HIV test results (eg. rapid tests) must be confirmed with a confirmatory test in the laboratory.
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Follow-up diagnostic test for HCV
If a test is positive for HCV antibodies, a nucleic acid test for HCV ribonucleic acid (RNA) is needed to confirm chronic infection.
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New types of test: home test/self-testing and self-sampling test
Home test and self-tests are becoming more popular in European countries, which are looking for ways to increase number of people tested for HIV and HCV.
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Different types of tests - additional resources
In this module participants will get to know:
- The standards of pre-test and post-test counselling;
- The procedure of counselling;
- Importance of counselling.
Pre- and post-test counselling - introduction
According to World Health Organization (WHO), voluntary HIV testing and counselling (VTC) should be routinely
offered to all key populations.
Principles of pre- post-test counselling
HIV testing must always be done with informed consent, adequate pre-test information or counselling, post-test counselling, protection of confidentiality and referral to services.
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Two components of HIV/HCV counselling
HIV/HCV counselling encompasses two components: provision of information and prevention counselling.
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Informed consent and risk assessment
The client has to be informed of the right to refuse to take the test and of the fact that declining an HIV test will not affect his access to services.
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Post-test counselling and communication of test results
Post-test counselling must always be an integral component of the HIV/HCV testing process.
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Ethical considerations and importance of training
Clients should receive adequate information enabling them to make a personal and voluntary decision whether to decline one or all of the proposed tests without coercion.
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Counselling - additional resources
By the end of the module you will be able to:
- Understand philosophy of harm reduction;
- Have concrete plans for developing their existing services and adding new services;
- Understand public health ethical priorities of low-threshold services and negligence of not addressing behaviours that cause infections;
- Engage PWUD in discussions about minimizing risks.
Attracting clients - introduction
For planning any kind of project or activities involving local communities, the first step should be the analysis of the local situation and local needs.
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Low threshold services
The term “low-threshold” is used to describe a setting which aims to facilitate access by people who use drugs to social and health services.
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Harm reduction philosophy
People who use drugs are often reluctant to use traditional healthcare services and are more comfortable requesting health support in harm reduction services, opioid substitution treatment programs or addiction services.
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Peer involvement
A large body of evidence indicates that peer-run initiatives can extend the reach and effectiveness of conventional public health programs by reaching high-risk PWUD.
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Attracting clients - additional resources
In this module participants will learn to:
- Offer suggestions for mainstreaming gender into existing services for PWUD;
- Expand access to women who use drugs (WUD) through appropriate gender-sensitive and gender-specific services;
- Address gender issues within existing services and/or to develop gender-specific services;
- Setting targets for scale-up to improve access to comprehensive HIV and care services, expanding coverage among WUD.
Gender-specific approach - introduction
There are many sound public health and human rights recommendations that indicate the need for Harm Reduction (HR) and other HIV related services to specifically address the needs and preferences of women who use drugs.
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Alcohol, other drugs and pregnancy
Alcohol and other drug (AOD) use have effects on sexual and reproductive health which can sometimes cause severe consequences.
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Contraception in WUD
The main objective of contraception for WUD is - as it is for all other women- to avoid unwanted pregnancies and prevent abortion.
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Harm Reduction during pregnancy
Even when WUD cannot stop using drugs, even when methadone or buprenorphine are not available, there are some things that can be done to improve their health and that of their babies.
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Opioid substitution therapy
Lots of evidence has been collected in support of the medical and social benefits of OST for opiate users, including during pregnancy.
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Women who use drugs, HIV and Hepatitis
Social stigma attached to WUD and HIV can represent a huge barrier to their access to harm reduction services.
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Violence agains women who use drugs
Violence against women is endemic worldwide and, despite all the human rights efforts, campaigns and interventions at all levels, it seems to have no easy solution.
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WUD in prison settings
Women in prison, compare to men, are at much higher risk to be infected with HIV, HCV during unprotected sex. WUD in prisons should have equivalent access to gender-sensitive health and HIV services as their non-incarcerated counterparts in the community.
See more... Published: 2022
Gender specific approach - recommendations
Gender specific approach - additional resources
By the end of the module participants will understand:
- Integrated approaches in relation to substance use and HIV/HCV testing;
- The role of low threshold settings in improving linkage;
- Main barriers to service integration;
- What can be done to support linkage.
Linkage to care - introduction
Low threshold services play a crucial role in HIV/HCV testing and linkage to care.
See more... Published: 2022
Integrated care
Integrated Care is a concept bringing together inputs, delivery, management and organization of services related to diagnosis, treatment, care, rehabilitation and health promotion. Integration is a means to improve the services in relation to access, quality, user satisfaction and efficiency.
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Barriers to linkage
Multiple factors may hinder the successful uptake of testing and linkage to care and prevention.
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What can be done to support integrated care?
Integrated care can be supported by investing in and applying the tools available for integrated care.
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Linkage to care - additional resources
In this module participants will learn about:
- Quality improvement tools;
- How to choose the right tool;
- The meaning of quality.
What is quality improvement?
Quality improvement (QI) is an important part of work for every organization, especially those, providing lifesaving services for people.
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Quality improvement tools
Quality improvement tools might be used during project planning or during implementation of a project.
See more... Published: 2022In the final module participants will learn about:
- An example of a German testing intervention for prison;
- Requirements for test interventions in prison settings;
- Standards for HIV and HCV testing in prison settings.
Prison as places for public health interventions
Each year about 110.000 people get imprisoned for the first time in Germany. There is a high turnover rate: citizens arrive and depart on a daily basis. Among those incarcerated are highly vulnerable people who use drugs (PWUD) due to prohibitive drug laws.
See more... Published: 2022
Voluntary counseling and testing standards (VCT) in prison
VCT standards demand that HIV testing be performed with informed consent.
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Linkage to care in prison settings
HIV testing without an offer to link it to care is problematic. In this respect, it is problematic that prisoners cannot choose the doctor who treats them.
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Developing an exemplary intervention in Germany
If carefully undertaken, VCT in prison needs a lot of time. Physicians in prison with their multitude of other responsibilities sometimes do not have adequate amount of time.
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Prison settings - additional resources
