Presentation at the EU session "Elimination of hepatitis B and C in the EU: challenges and opportunities", at the International Liver Congress (ILC) 2017, Amsterdam. Presenter: Dagmar Hedrich, European Monitoring Centre for Drugs and Drug Addiction (EMCDDA).

1. The status of HCV prevention among
people who inject drugs: an overview of
the European response and the structural
challenges
Dagmar Hedrich, EMCDDA
ILC, Amsterdam, 23 April 2017
Elimination of hepatitis B and C in the EU: challenges and opportunities

2. Faculty Disclosure Information Elements
1. Dagmar Hedrich, EMCDDA
2. The status of prevention among people who
inject drugs: an overview of the European
response and the structural challenges.
3. “No relevant financial relationship exists.”

3. Setting the scene

4. Global figures
4
• Estimated 12 million PWID
worldwide
• One in two PWID has
HCV-antibodies (6 million)
• > 80% of PWID living with
HIV are co-infected with
HCV
UN World Drug Report 2016
• Injection drug use
accounts for 23% of new
HCV infections
WHO Global Hepatitis Report 2017

5. 5
HCV among PWID in Europe
In Europe, people who
inject drugs are a major,
if not the main HCV
transmission risk group.
A significant proportion
has not been diagnosed.
There is a lack of access
to testing and treatment.
Hickman & Martin (Eds.) EMCDDA, 2016

6. HCV antibody prevalence among PWID
6
Source: EDR 2016
… plus
potentially large
population of ex-
injectors
40-80% in most
studies among
current injectors
Recent rapid
increase in HCV
prevalence in
Hungary:

7. What works
in HCV prevention

8. Effective responses are known
8
Joint ECDC/EMCDDA Guidance:
Prevention and control of infectious
diseases among PWID
Seven recommended measures
• Injection equipment, paraphernalia
• Vaccination
• Drug dependence treatment
• Testing
• Infectious diseases treatment
• Health promotion
• Targeted delivery of services
Seven interventions,
one aim: no infections

9. Prevention coverage
in Europe

10. Percentage of high-risk opioid users receiving
opioid substitution treatment, 2015
10

11. 11
Syringes: geographical coverage of sites
Number per estimated PWID
Syringes distributed through specialised
programmes per estimated IDU, 2014
Geo-coverage: Outlets providing free
injecting equipment
(% of NUTS-III territorial units)
(shows NUTS-II for AT, IT, NL, ES)

12. A highly targeted prevention response:
Supervised drug consumption facilities
12

13. Hepatitis B vaccination:
risk group specific campaigns for PWID
13
National policy of targeted vaccination of PWID (9):
Germany, Ireland, United Kingdom, Norway.
incl. vaccination as regular offer
at drug treatment services:
Croatia, France
Italy, Malta, Slovenia.
Local campaigns (5):
Belgium, Spain, Austria,
Portugal, Romania.
(Results of survey among 30 national Focal Points, 2014.
Next information update: October 2017)

14. Structural challenges

15. Challenges
15
 Stigma and marginalisation of drug users;
 Low acceptance of harm reduction in some EU countries
 Many unaware of infection, delaying entry into effective
treatment: community-based testing not legally possible in
some countries;
 Changing drug situation: new use patterns, risk groups;
 High endemicity: need to strengthen harm reduction and HCV
treatment;
 Reinfection prevention.

16. Developments
16
 More conducive HCV treatment policy frameworks;
 Use of community-based testing growing;
 Good practices in referral and treatment pathways developing;
 Collaboration clinical/hepatology and addiction care improving;
 Despite increasing effectiveness of HCV treatment,
prevention is essential and must
not be neglected.

17. emcdda.europa.eu
twitter.com/emcdda
facebook.com/emcdda
flickr.com/photos/emcdda
youtube.com/emcddatube
RTX Focal Points, DRID expert network
EMCDDA colleagues Eleni Kalamara,
and Isabelle Giraudon
Acknowledgements
dagmar.hedrich@emcdda.europa.eu