Tag: people who inject drugs

Increasing linkage to care and adherence to treatment for hepatitis C among people who inject drugs

Posted on by Milutin

Hepatitis C virus (HCV) infection is a major public health threat due to disease burden and risk of complications and death. Injecting drug use is the most likely mode of HCV transmission reported in the EU/EEA and accounted for 49% of acute and 61% of chronic infections in 2018. Compared to other drug-associated blood-borne viral infections, HCV is the most prevalent one among people who inject drugs (PWID) across Europe. Prevalence of HCV antibody among PWID estimated from nationally representative samples ranged between 15% and 86% during 2018–2019. The prevalence of current infections measured by HCV-RNA (or antigen) tests ranged from 15% to 64% between 2013 and 2019 in six countries with available data. PWID are therefore considered as a priority population in prevention, testing, linkage to care and treatment, and prevention of re-infections to achieve HCV elimination.

Following advances in treatment for hepatitis C (HCV), optimizing linkage to care and adherence to treatment of people who inject drugs became of pivotal importance. An ECDC/EMCDDA stakeholders survey in 2018 indicated that two components of the cascade of care, linkage to care and adherence to treatment, were priority areas for inclusion in the updated guidance, planned for publication in 2022. The systematic review Interventions to increase linkage to care and adherence to treatment for hepatitis C among people who inject drugs: A systematic review and practical considerations from an expert panel consultation was commissioned with the aim to evaluate the effectiveness of interventions on HCV linkage to care and adherence to treatment among people who inject drugs.

Available evidence suggests that integrated, people-centered approaches may improve engagement throughout the continuum of HCV care among people who inject drugs. For progressing HCV elimination efforts, interventions should be implemented in colocation with harm reduction and counselling activities and in combination with additional services, including opioid substitution treatment, directly observed therapy, peer support and/or contingency management.

Highlights of the review include:

  • Integrated care and cooperation between service providers optimize the HCV care continuum among people who inject drugs.
  • Results suggest that people who inject drugs with HCV infection can be effectively linked and treated with direct-acting antivirals regimens in settings outside of hospital.
  • Interventions that facilitate HCV care must be implemented at settings where people who inject drugs are already accessing services.
  • The experts’ reflections complement the findings of the literature review and inform public health practice by considering the heterogeneity of health systems and national regulatory frameworks.
  • Higher quality studies investigating interventions addressing the entire care cascade from testing to cure and prevention of reinfections among highly vulnerable populations are urgently needed.

To read the full article, follow this link>>>.

 

Reducing incarceration will reduce harm

Posted on by Milutin

The Harm Reduction International published the briefing The Harms of Incarceration: The evidence base and human rights framework for decarceration and harm reduction in prisons. It provides advocates with the evidence base and human rights framework for decarceration and the provision of harm reduction services in prisons.

The document provide evidence that:

  • The first step in reducing harm associated with incarceration is to reduce reliance on incarceration itself.
  • Providing harm reduction is a human rights obligation.
  • Harm reduction services in prisons are an essential, effective and safe public health measure.
  • People in prison are severely underserved by harm reduction services.

The highlights of the briefing inslude:

Over 11 million people are imprisoned worldwide today, the highest number ever recorded. One in five people in prison worldwide is held for drug offences, and 90% of people who inject drugs will be incarcerated at some point in their life. People in prison are at greater risk of HIV, hepatitis C, tuberculosis and COVID-19. When they are released from prison, their risk of overdose increases by up to 69-times.

People in prison retain their human rights, which includes their right to health. By withholding health services such as harm reduction from them, states are violating this right. In some cases, withholding essential services like opioid agonist therapy amounts to torture. The UN Special Rapporteur on Health, the European Convention on Human Rights, and the Nelson Mandela Rules on the treatment of prisoners all oblige states to provide health services in prisons.

Harm reduction works. Robust evidence shows that harm reduction services reduce transmission of HIV and viral hepatitis, reduce risk behaviours, reduce deaths from all causes, and can even reduce chances of people coming back to prison. This is why the World Health Organisation, UNAIDS and UN Office on Drugs and Crime all support harm reduction in prisons.

Even though states are obliged to provide the same standard of healthcare inside and outside prisons, when it comes to harm reduction, they do not do so. In nearly a third of countries where opioid agonist therapy is available, people in prison have no access. In 88% of countries where needle and syringe programmes operate, there are none in prisons. Even where services are available in prisons, there are frequently barriers that make them inaccessible in practice.

To read full briefing, follow this link>>>.

 

A report on the global qualitative study

Posted on by Milutin

The International Network of People who Use Drugs (INPUD) has collaborated with the World Health Organization (WHO) Department for Global HIV, Hepatitis and STI Programmes on a global qualitative study examining the values and preferences of key populations, including people who inject drugs, for HIV, Hepatitis and STIs services. The findings of this study will inform the update of the WHO 2016 Consolidated Guidelines for HIV prevention, diagnosis, treatment and care for key populations. These Guidelines will be used to inform countries on the design and implementation of health packages for key populations, making it extremely important that they take into account the specific values and preferences of each key population included in the study (people who inject drugs, gay and bisexual men and other men who have sex with men, female, male and trans sex workers and trans people).

Across the globe, people who inject drugs continue to be at increased risk of HIV, viral hepatitis (HCV, viral hepatitis B (HBV) and tuberculosis (TB). In order to reduce HIV, HCV and HBV transmissions along with overdose deaths, a comprehensive package of harm reduction interventions must be made available to people who inject drugs. Although such interventions are considered by the WHO and other UN agencies as essential to achieve global targets, access to harm reduction is still limited or non-existent in many countries, with less than 1% of people who inject drugs having sufficient access to services. Structural barriers caused by the criminalisation of drugs and the accompanying stigma and discrimination directed towards people who inject drugs are among the biggest contributors to this problem.

As one of the four key population networks included in the study, INPUD conducted eight regional focus group discussions and ten semi structured interviews with people who use drugs from 27 total countries. This report is a summary of our key findings that will be used to update the Consolidated Guidelines with the values and preferences of people who inject drugs.

The findings of this research emphasise the critical importance of listening to the values and preferences of people who inject drugs to guide services and interventions and ensure there is a primary focus on delivering genuine person centred care.

The report is available following this link>>>.

 

Collection of models of good practice

Posted on by Milutin

The European Centre for Disease Prevention and Control (ECDC) and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) Guidance Prevention and control of infectious diseases among people who inject drugs identifies good practice for prevention and control of infectious diseases among people who inject drugs. This guidance aims to support policy makers in Europe to plan adequate, evidence-based, pragmatic, and rationally designed public health responses for the prevention and control of infections among people who inject drugs. It aims at public health programme planners and decision makers working in the fields of infectious diseases, general public health, addiction and mental healthcare, social services, and drug control at national and regional levels.

Published n 2011, the Guidance is currently being updated. In addition to ongoing systematic reviews of peer-reviewed literature, a collection of models of good practice has been initiated by the two agencies, that should add practice-based evidence derived from interventions implemented in real-life, European settings.

The two EU agencies are inviting applications to report models of good practice targeting PWID population aiming to:

  • improve community-based testing
  • increase linkage to care
  • increase adherence to treatment of infection interventions
  • prevention or reduction of infections through successful health promotion approaches

The infections of interest are hepatitis B (HBV), hepatitis C (HCV), HIV and tuberculosis (TB).

Should you or your organisation be interested in reporting a model of good practice that fits the scope of this call, please express your interest following this link>>>.

Legal needs and access to justice for people who inject drugs and sex workers in Macedonia

Posted on by Milutin

Our member organisation HOPS published the Research report: Legal needs and access to justice for people who inject drugs and sex workers in Macedonia.

This research represents the first effort to assess the legal needs and paths to justice for people who inject drugs and sex workers in Macedonia. It was conducted at the end of 2016 and the beginning of 2017 using a mixed-methods research approach. The quantitative phase included 250 respondents chosen through stratified random sampling, out of which 169 inject/injected drugs, and 107 are/were engaged in sex work over the last three and a half years. The qualitative research phase, on the other hand, was comprised of focus group discussions with 69 respondents from both communities, as well as individual or group interviews with 7 representatives from competent institutions.

The research results showed that people who inject drugs and sex workers in Macedonia experience ten times more non-trivial justiciable problems in comparison to the general population in the country. In addition, low level of legal literacy, lack of trust in institutions and systemic discrimination, among other factors, prevent citizens from these communities to seek protection of their rights and delivery of justice through institutional mechanisms. Such circumstances confirm the communities’ high vulnerability and underline the need for advancement of their access to information, legal advice and protection.

The findings pinpoint the necessity to educate people who inject drugs and sex workers on existing institutional mechanisms for protection of rights and delivery of justice, and motivate them to take actions towards legal resolution. Since citizens from these groups trust civil society organizations the most, CSOs are the first instance where they seek free legal advice and aid. Hence, services offered to these communities by civil society organizations need to be developed further, while also advancing the cooperation between the organizations and the competent institutions, including introduction of functional referral mechanisms.

Recommendations of the report also include that overcoming prejudices against people who inject drugs and sex workers in institutions responsible for ensuring the legal order, such as the police, Legal Needs and Access to Justice for People Who Inject Drugs and Sex Workers in Macedonia prosecutors, courts and prisons is crucial. This could be achieved with temporary measures, such as trainings, field and study visits, but also through more sustainable systemic changes in the process of professional training of employees in the aforementioned institutions. Similar measures could be useful for health and social workers

To read full report follow this link>>>>. Version of the report in Macedonian is available following this link >>>>.