Eliminating Hepatitis C in Europe: Insights from a Civil Society Monitoring of Harm Reduction in Europe.

This study presents the findings of a five-year consecutive survey conducted by Correlation- European Harm Reduction Network (C-EHRN) across 35 European cities in 32 countries to assess the availability and access to interventions constituting the HCV continuum of care for people who inject drugs.  HCV care in 35 European cities in 2023 is described, and comparisons are drawn for 25 cities consistently responding from 2020 to 2023. 

In spring 2023, 2022, 2021 and 2020, C-EHRN invited civil society organizations from European countries to complete a 25-item online questionnaire featuring both single and multiple-choice questions and open-ended inquiries. The questionnaire comprised four parts, addressing national strategies, continuum-of-care functioning, changes from the previous year, and the role of harm reduction services. Focal points within C-EHRN, serving as local reference points, represented survey respondents. 

Data analysis reveals persistent barriers hindering the scaling up of HCV services in various cities and countries. Notable challenges include Direct-Acting Antivirals (DAAs) restrictions, financial obstacles related to testing and treatment, and limited advancements in simplifying care pathways, task delegation, and community access. Stigma and discrimination against people who inject drugs persist in healthcare settings, with an alarming lack of monitoring for discrimination in HCV treatment.

Despite improvements in HCV awareness campaigns and testing services, challenges persist in non-invasive diagnostic procedures, treatment services, and harm reduction organisations. Positive developmental trajectories have re-emerged post-pandemic after a downward trend in 2020 and 2021, but many cities and countries still lack sufficient progress. 

Recommendations to enhance HCV care among people who inject drugs in Europe include advocacy efforts for unrestricted DAA access and reimbursement; implementation of anti-stigma campaigns and training programs; ensuring free and accessible HCV testing, expanding testing points, removing prescription requirements, and expanding treatment locations; establishment of post-diagnosis follow-up programs; supporting and expanding HCV awareness campaigns; increasing access to non-invasive diagnostic procedures; monitoring and improving HCV treatment services; and addressing limitations faced by harm reduction organisations, including securing funding, integration, and staff resources, with advocacy for political support.

By the time of the presentation, we also have 2024 data available, so we can see if the development described above has changed.