Yela Elena, Abiétar Daniel G, Clua-García Rafael
Sant Esteve Sesrovires Prison Primary Care Team (Brians 1 Prison Centre), Catalan Health Institute, Barcelona, Spain.
Institut Universitari d'Investigació en Atenció Primària Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.
Harm Reduct J. 2025 Jul 31;22(1):133. doi: 10.1186/s12954-025-01286-w.
The Spanish National Health System, with devolved powers to autonomous communities such as Catalonia, faces significant challenges in controlling viral infections like hepatitis C (HCV) among vulnerable groups, particularly people who inject drugs (PWID), where prisons serve as crucial intervention sites. Catalonia's health authorities have implemented strategies to combat HCV, including direct-acting antiviral (DAA) treatments and harm reduction programmes within both community and penitentiary settings. However, substantial barriers persist in achieving full treatment uptake and clearance among PWID subpopulations.
This review aims to discuss the Catalonia's current HCV programmes and explores intervention proposals needed to achieve WHO elimination targets. Catalonia has implemented a comprehensive HCV plan, particularly targeting PWID, that has proven effective through enhanced screening, universal treatment access, and harm reduction, though structural and social barriers remain due to fragmented health and social systems.
Advancing towards HCV elimination requires strengthened inter-organisational coordination, integrated social and health services, simplified care pathways, enhanced screening, professional training, targeted research, measurable goals, culturally appropriate and participatory prevention strategies, and a comprehensive, people-centred approach. This is particularly important in prisons, where universal screening, adapted caring processes, harm reduction, and opioid substitution treatments (OST) are essential. Considering the social determinants of health perspective, it is essential that policies and programs are structured to reduce structural inequities and vulnerabilities, thereby promoting equity in both access to prevention, care, treatment, and health benefits across all population groups, particularly those most affected.
西班牙国家卫生系统将权力下放给加泰罗尼亚等自治区，在控制弱势群体（尤其是注射吸毒者）中的丙型肝炎病毒（HCV）感染方面面临重大挑战，监狱是关键的干预场所。加泰罗尼亚卫生当局已实施了抗击HCV的策略，包括在社区和监狱环境中开展直接抗病毒药物（DAA）治疗和减少伤害计划。然而，在实现注射吸毒者亚群体的全面治疗覆盖和病毒清除方面，仍然存在重大障碍。
本综述旨在讨论加泰罗尼亚目前的HCV项目，并探索实现世界卫生组织消除目标所需的干预建议。加泰罗尼亚实施了一项全面的HCV计划，尤其针对注射吸毒者，该计划通过加强筛查、普及治疗和减少伤害已证明是有效的，尽管由于卫生和社会系统分散，仍然存在结构和社会障碍。
朝着消除HCV迈进需要加强组织间协调、整合社会和卫生服务、简化护理途径、加强筛查、专业培训、针对性研究、可衡量的目标、文化适宜且参与性强的预防策略，以及全面的、以人为本的方法。这在监狱中尤为重要，在监狱中普遍筛查、适应性护理流程、减少伤害和阿片类药物替代治疗（OST）至关重要。从健康的社会决定因素角度来看，至关重要的是，政策和项目的制定应减少结构性不平等和脆弱性，从而促进所有人群，特别是受影响最严重人群在预防、护理、治疗和健康福利获取方面的公平性。
