Background: People who inject drugs (PWID) account for the majority of new cases of hepatitis C virus (HCV) infec‑ tion in Europe; however, HCV testing, and treatment for PWID remain suboptimal. With the advent of direct acting antivirals (DAAs) the World Health Organization (WHO) adopted a strategy to eliminate HCV as public health threat by 2030. To achieve this, key policies for PWID must be implemented and HCV continuum of care needs to be monitored. This study presents results of the frst monitoring led by civil society that provide harm reduction services for PWID.
Methods: In 2019, harm reduction civil society organizations representing focal points of Correlation-European Harm Reduction Network in 36 European countries were invited to complete a 27-item online survey on four strategic felds: use/impact of guidelines on HCV testing and treatment for PWID, availability/functioning of continuum of care, changes compared to the previous year and, the role of harm reduction services and non-governmental organiza‑ tions (NGOs) of PWID. A descriptive analysis of the responses was undertaken.
Results: The response rate was 97.2%. Six countries reported having no guidelines on HCV treatment (17.1%). Twenty-three (65.7%) reported having treatment guidelines with specifc measures for PWID; guidelines that impact on accessibility to HCV testing/treatment and improve access to harm reduction services in 95.6% and 86.3% of them, respectively. DAAs were available in 97.1% of countries; in 26.4% of them they were contraindicated for active drug users. HCV screening/confrmatory tests performed at harm reduction services/community centers, prisons and drug dependence clinics were reported from 80.0%/25.7%, 60.0%/48.6%, and 62.9%/34.3% of countries, respectively. Provision of DAAs at drug dependence clinics and prisons was reported from 34.3 to 42.9% of countries, respectively. Compared to the previous year, HCV awareness campaigns, testing and treatment on service providers’ own locations were reported to increase in 42.9%, 51.4% and 42.9% of countries, respectively. NGOs of PWID conducted awareness campaigns on HCV interventions in 68.9% of countries, and 25.7% of countries had no such support.
Conclusion: Further improvements in continuum-of-care interventions for PWID are needed, which could be achieved by including harm reduction and PWID organizations in strategic planning of testing and treatment and in eforts to monitor progress toward WHO 2030 elimination goal.
Keywords: Hepatitis C, People who inject drugs, Continuum of care, Harm reduction, Civil society, Monitoring
Background: Hepatitis C virus (HCV) infections in people who inject drugs (PWID) can now be treated and cured. However, the impact that HCV treatment has on drug-user health, practices and wellbeing is not known. The aim of this research was to understand the non-clinical impact that HCV treatment has in PWID and their reasons for accessing and completing treatment.
Methods: Participants aged 25–67 years who had injected opioids or stimulants (currently or in the past) and had completed direct-acting antiviral treatment were recruited from seven European countries. Participants completed a 30-min online survey administered face-to-face between September 2018 and April 2019. The questionnaire responses were used to assess the mental and physical impact of having completed treatment.
Results: Of the 124 participants who completed the survey questionnaire, 75% were male, 69% were over 45 years old and 65% were using opioids and/or stimulants at the start of HCV treatment. Participants reported improvements in the following areas after completing HCV treatment: outlook for the future (79%); self-esteem (73%); ability to plan for the future (69%); belief in their abilities (68%); confidence (67%); empowerment (62%); energy levels (59%); and ability to look after themselves (58%). The most common reasons for starting HCV treatment were: becoming aware of treatments that were well tolerated (77%) and effective (75%); and understanding the potentially severe consequences of HCV (75%).
Conclusions: The benefits of HCV treatment go beyond clinical outcomes and are linked to improved drug-user health and wellbeing. Sharing information about well-tolerated and effective HCV treatments, and raising awareness about the potentially severe consequences of untreated HCV are likely to increase the number of PWID who are motivated to access and complete HCV treatment in future.
Keywords: Hepatitis C, Outcomes, Experience, People who inject drugs, Mental health, Physical wellbeing
Background: Marginalised communities such as homeless people, people who use drugs (PWUD), lesbian, gay, bisexual, transgender and intersex people (LGBTI), prisoners, sex workers and undocumented migrants are at high risk of poor health and yet face substantial barriers in accessing health and support services. The Nobody Left Outside (NLO) Service Design Checklist aims to promote a collaborative, evidence-based approach to service design and monitoring based on equity, non-discrimination and community engagement.
Methods: The Checklist was a collaborative project involving nine community advocacy organisations, with a focus on homeless people, PWUD, LGBTI people, prisoners, sex workers, and undocumented migrants. The Checklist was devised via a literature review; two NLO platform meetings; a multistakeholder policy workshop and an associated published concept paper; two conference presentations; and stakeholder consultation via a European Commission-led Thematic Network (including webinar). Results The NLO Checklist has six sections in line with the WHO Health Systems Framework. These are: (1) service delivery, comprising design stage (6 items), services provided (2 items), accessibility and adaptation (16 items), peer support (2 items); (2) health workforce (12 items); (3) health information systems (7 items); (4) medical products and technologies (1 item); (5) financing (3 items); and (6) leadership and governance (7 items). It promotes the implementation of integrated (colocated or linked) healthcare services that are community based and people centred. These should provide a continuum of needs-based health promotion, disease prevention, diagnosis, treatment and management, together with housing, legal and social support services, in alignment with the goals of universal health coverage and the WHO frameworks on integrated, people-centred healthcare.
Conclusions: The Checklist is offered as a practical tool to help overcome inequalities in access to health and support services. Policymakers, public health bodies, healthcare authorities, practitioner bodies, peer support workers and non-governmental organisations can use it when developing, updating or monitoring services for target groups. It may also assist civil society in wider advocacy efforts to improve access for underserved communities
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This is the second civil society-led monitoring report produced by Correlation – European Harm Reduction Network (C-EHRN) within the context of our operational grant from the European Commission. The purpose of this report is to enrich the information and knowledge base of harm reduction interventions in Europe from the viewpoint of civil society organisations. We believe that this approach is a necessary, and useful, contribution to the development of drug policy in the region. We learned a lot from the former process and the 2019 edition and modified the approach, the focus and certain questions to enable respondents to report closer to their own experiences. Consequently, the information provided in this report sometimes represents the situation in a particular city or region and informs us as to the experiences of a specific organisation in the field. Such ‘real life’ information can contribute significantly to an understanding of the advantages, barriers and challenges of drug policy. Even stronger, we directly approached representatives of networks and organizations of people who use drugs to share their view on the developments with us. 2020, however, was not a regular year and the world wide pandemic had its influence on people, organisations and the care system in general. Accordingly, we added a section on the impact of COVID-19 on harm reduction services and we will continue to measure this impact. We will use the insights and information collected in this report within our advocacy efforts to strengthen harm reduction policies in Europe and, we hope, our partners and contributors will do the same in their environment at a regional and national level. More than one hundred organisations and individuals from 34 European countries have contributed to the collection of data with an amazingly high response rate; we thank all contributors for their great work and commitment. Without their engagement, this work would never have been undertaken at all. In particular, we would like to thank the authors of this report, Rafaela Rigoni, Tuukka Tammi, Daan van der Gouwe, and Victoria Oberzil, who were supported by the coordinators of the expert groups and the reviewers of this report. We are also grateful to HRI and Robert Czack for contributing with a chapter to this report. A special thanks to Dagmar Hedrich and her EMCDDA colleagues for their ongoing and patient support. We thank the European Commission, DG Sante, for their financial support and to the Regenboog Groep, Amsterdam, for their ongoing support of Correlation – European Harm Reduction Network