Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Harm Reduct J. 2024 Nov 20;21(1):203. doi: 10.1186/s12954-024-01115-6.
With the advent of direct acting antivirals (DAAs) the World Health Organisation (WHO) adopted global strategy to eliminate hepatitis C virus (HCV) infection by 2030. In Europe, people who inject drugs (PWID) account for the majority of new cases, however testing and treatment remain suboptimal. The aim was to monitor progress in HCV policy and cascade-of-care for PWID, led by the civil society organisations (CSO) that provide harm reduction services for PWID across Europe.
In period 2020-2023, CSOs representing focal points of Correlation-European Harm Reduction Network were annually invited to complete online questionnaire on use/impact of HCV test-and-treat guidelines for PWID, availability/functioning of continuum-of-care, and role/limitations of harm reduction services for PWID. A retrospective longitudinal analysis of responses to questions answered each year by the same respondents was performed, and a comparison among the studied years was made.
Twenty-five CSOs from cities in 25 European countries were included and responded to 25 questions. Between 2020 and 2023, there was positive trend in number of HCV treatment guidelines, separate guidelines for PWID, and their positive impact on acess to testing/treatment (24/25, 5/25, and 16/25 in 2023, respectively). DAAs were available in all countries, predominantly prescribed by specialist physicians only (slight increase at primary care), with restrictions including active drug use, stage of liver fibrosis or/and reimbursement policies (2/25, 4/25, and 3/25 in 2023, respectively). A decrease in HCV testing sites was noted. Treatment was consistently most common at clinical settings, however an increase outside the specialist settings was detected, particularly in prisons (12/25 and 15/25 in 2020-2021, respectively). Comparing 2022-2023, number of HCV-testing services increased in many cities with positive dynamic in nearly all the settings; increase in treatment at harm reduction services/community centres was noted (6/25 to 8/25, respectively). Between 2020 and 2023 the frequency of various limitations to CSOs addressing HCV was oscillating, presenting an increase between 2022 and 2023 (9/25 to 14/25, respectively).
The overall progress towards WHO HCV elimination goals across Europe remains insufficient, most probably also due to the influence of Covid-19 pandemic. Further improvements are needed, also by including CSOs for PWID in continuum-of-care services, and in monitoring progress.
随着直接作用抗病毒药物（DAAs）的出现，世界卫生组织（WHO）通过了到 2030 年消除丙型肝炎病毒（HCV）感染的全球战略。在欧洲，注射毒品者（PWID）占新发病例的大多数，但检测和治疗仍不理想。目的是监测由为欧洲 PWID 提供减少伤害服务的民间社会组织（CSO）领导的 HCV 政策和关怀链的进展情况。
在 2020 年至 2023 年期间，代表欧洲相关网络减少伤害协调中心的 CSO 每年都被邀请在线回答关于 PWID 的 HCV 检测和治疗指南的使用/影响、关怀链的连续性、以及减少伤害服务对 PWID 的作用/限制的问题。对同一受访者每年回答的问题进行了回顾性纵向分析，并对研究年份进行了比较。
25 个来自欧洲 25 个城市的 CSO 被纳入并回答了 25 个问题。2020 年至 2023 年期间，HCV 治疗指南、针对 PWID 的单独指南以及它们对检测/治疗的积极影响呈上升趋势（2023 年分别为 24/25、5/25 和 16/25）。所有国家都有 DAA 药物，主要由专科医生开具（初级保健略有增加），但存在一些限制，包括药物使用、肝纤维化分期或/和报销政策（2023 年分别为 2/25、4/25 和 3/25）。HCV 检测点的数量有所减少。治疗一直是在临床环境中最常见的，但也发现了在专科环境之外的治疗有所增加，尤其是在监狱（2020-2021 年分别为 12/25 和 15/25）。比较 2022-2023 年，许多城市的 HCV 检测服务数量有所增加，几乎所有环境都呈现出积极的动态；在减少伤害服务/社区中心的治疗有所增加（2022 年分别为 6/25 和 8/25）。2020 年至 2023 年期间，CSO 解决 HCV 问题的各种限制的频率呈波动状态，2022 年至 2023 年期间呈上升趋势（2022 年分别为 9/25 和 14/25）。
欧洲在实现世卫组织 HCV 消除目标方面总体进展仍然不足，这很可能也受到了新冠疫情的影响。还需要进一步改进，包括将 PWID 的 CSO 纳入关怀链服务，并监测进展情况。
