Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Harm Reduct J. 2020 Nov 19;17(1):89. doi: 10.1186/s12954-020-00439-3.
People who inject drugs (PWID) account for the majority of new cases of hepatitis C virus (HCV) infection 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 first monitoring led by civil society that provide harm reduction services for PWID.
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 fields: 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 organizations (NGOs) of PWID. A descriptive analysis of the responses was undertaken.
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 specific 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/confirmatory 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.
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 efforts to monitor progress toward WHO 2030 elimination goal.
在欧洲，注射吸毒者（PWID）占丙型肝炎病毒（HCV）新感染病例的大多数；然而，HCV 检测和 PWID 的治疗仍然不理想。随着直接作用抗病毒药物（DAAs）的出现，世界卫生组织（WHO）通过了一项到 2030 年消除 HCV 作为公共卫生威胁的战略。为此，必须实施针对 PWID 的关键政策，并监测 HCV 护理连续体。本研究介绍了由民间社会领导的首次监测结果，该监测为 PWID 提供减少伤害服务。
2019 年，代表欧洲关联-减少伤害网络 36 个欧洲国家协调中心的减少伤害民间社会组织应邀完成了一项关于四个战略领域的 27 项在线调查：HCV 检测和治疗 PWID 指南的使用/影响、护理连续体的提供/运作、与前一年相比的变化，以及减少伤害服务和非政府组织（非政府组织）在 PWID 中的作用。对答复进行了描述性分析。
回应率为 97.2%。六个国家报告没有 HCV 治疗指南（17.1%）。23 个国家（65.7%）报告有针对 PWID 的治疗指南；这些指南对 HCV 检测/治疗的可及性产生影响，并分别使 95.6%和 86.3%的国家能够改善获得减少伤害服务的机会。97.1%的国家都有 DAA；其中 26.4%的国家对活性药物使用者有禁忌症。分别有 80.0%/25.7%、60.0%/48.6%和 62.9%/34.3%的国家报告在减少伤害服务/社区中心、监狱和药物依赖诊所进行 HCV 筛查/确诊试验。分别有 34.3%至 42.9%的国家报告在药物依赖诊所和监狱提供 DAA。与前一年相比，报告称在服务提供者自己的地点开展 HCV 宣传活动、检测和治疗的国家分别增加了 42.9%、51.4%和 42.9%。PWID 的非政府组织在 68.9%的国家开展了 HCV 干预宣传活动，而 25.7%的国家没有这种支持。
需要进一步改善 PWID 的护理连续体干预措施，可以通过将减少伤害和 PWID 组织纳入检测和治疗的战略规划以及努力监测世卫组织 2030 年消除目标的进展来实现。
