Monitoring the elimination of hepatitis C and B among people who inject drugs in Europe
In 2016, WHO Europe launched an action plan for the health sector response to viral hepatitis in the WHO European region. The goal is to achieve a reduction in the incidence of chronic hepatitis C and B infections of 90% by 2030, and a reduction in the mortality from chronic infections of 65% by 2030. People who inject drugs (PWID) are disproportionally affected and therefore a key group for the elimination strategy. As a complement to the EU monitoring platform, the EMCDDA is working with the drug-related infectious diseases (DRID) network on a PWID-specific list of indicators – the elimination barometer - in order to identify data gaps and to assess the progress towards elimination in this group. We document here each of the 5 building blocks of the barometer for the European Union, Norway and Turkey (EU30).
The elimination barometer among PWID was adapted from the WHO evaluation and monitoring framework. It includes 12 core indicators from 5 building blocks: Context and need, policy inputs, prevention, testing and linkage to care, and impact. Quantitative indicators are reported annually by the DRID network to EMCDDA through its online standardised data collection tool. Qualitative information is reported by national experts to the EMCDDA through the workbooks and responses to ad hoc queries.
Context and needs: the latest national estimated number of PWID ranged from less than 1 per 1000 to more than 10 per 1000 inhabitants aged 15-64 years. In 2016-17, the prevalence of antibodies to Hepatitis C virus (HCV) among PWID available from 18 countries varied from 15% to 82%. Between 1.4% and 9.4% of PWID were estimated to be currently infected with hepatitis B virus (HBV) (data from 5 countries). Policy inputs: by January 2019, 18 EU countries and Norway had an official national viral hepatitis policy inclusive of PWID, and in another four, policies were in preparation. Prevention: in 2017, in four out of 16 countries with current PWID estimates, the yearly number of clean syringes distributed per PWID was above the 2020 target of 200 syringes. Testing and linkage to care: for 9 out of 14 countries reporting this information, less than half of PWID entering treatment reported an HCV test in the last year. By March 2018, clinical guidelines in 8 countries still restricted HCV-DAA treatment access to PWID. Impact: a HCV-ab prevalence >10% in 2016-17 among PWID who have been injecting for less than 2 years shows that HCV transmission is still high and on-going among this group.
Conclusions and recommendations
Despite their cost-effectiveness, the documented coverage of prevention and harm-reduction measures for PWID are below target in many EU30 countries. While more inclusive national policies have been adopted since 2015, barriers remain for their implementation. Drug services and prisons are key settings for scaling-up integrated testing and treatment. In 2018, the EMCDDA launched a three year initiative in order to support countries’ efforts towards the viral hepatitis elimination goals by promoting hepatitis C testing among PWID in drug treatment settings.