HIV and HCV rapid testing in low threshold settings for PWUD

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.

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.

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.

The hepatitis C virus is a blood-borne virus. It is most commonly transmitted through exposure to small quantities of blood.

There are number of good reasons why people should get tested for HIV.

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.

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.

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.

Tuberculosis (TB) is an infectious disease that, unlike HIV and hepatitis, is caused not by viruses but bacteria.

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.

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.

All reactive primary HIV test results (eg. rapid tests) must be confirmed with a confirmatory test in the laboratory.

If a test is positive for HCV antibodies, a nucleic acid test for HCV ribonucleic acid (RNA) is needed to confirm chronic infection.

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.

According to World Health Organization (WHO), voluntary HIV testing and counselling (VTC) should be routinely
offered to all key populations.

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.

HIV/HCV counselling encompasses two components: provision of information and prevention counselling.

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.

Post-test counselling must always be an integral component of the HIV/HCV testing process.

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.

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.

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.

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.

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.

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.

Alcohol and other drug (AOD) use have effects on sexual and reproductive health which can sometimes cause severe consequences.

The main objective of contraception for WUD is - as it is for all other women- to avoid unwanted pregnancies and prevent abortion.

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.

Lots of evidence has been collected in support of the medical and social benefits of OST for opiate users, including during pregnancy.

Social stigma attached to WUD and HIV can represent a huge barrier to their access to harm reduction services.

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.

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.

Low threshold services play a crucial role in HIV/HCV testing and linkage to 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.

Multiple factors may hinder the successful uptake of testing and linkage to care and prevention.

Integrated care can be supported by investing in and applying the tools available for integrated care.

Quality improvement (QI) is an important part of work for every organization, especially those, providing lifesaving services for people.

Quality improvement tools might be used during project planning or during implementation of a project.

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.

VCT standards demand that HIV testing be performed with informed consent.

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.

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.