HA-REACT Joint Action on HIV and co- infection prevention and ...

HA-REACT Joint Action on HIV and co-infection

prevention and harm reduction

3rd EU Health Programme

Call: HP-JA-2014, Topic: JA-02-2014

9.4.2015 Mika Salminen/Outi Karvonen 1

A proposal for a Joint Action project under the EU Health Programme 2014 call

• Addresses Annual Work Programme, subheading 2.2.1.2. “Improvement of HIV and co-infection prevention and treatment in priority regions and priority groups in the European Union”

• Addresses all 4 priorities of the programme:

– promoting healthy lifestyles

– protection from cross border threats

– contributes to priorities 3 and 4, as several work packages of the proposal address the access to care in particularly vulnerable groups and settings

• Addresses the Communication from the Commission [COM(2009)569] on “Combating HIV/AIDS in the European Union and neighbouring countries, 2009 -2013” and its [SWD(2014)106] action plan extension 2014-2016


Persons who inject drugs (PWID) are at increased risk of infections

• HIV, TB and hepatitis B/C infection are still very relevant health problems in the EU for people who inject drugs.

• Poor access to safe injection equipment leads to sharing, creating high risk of blood-borne epidemics

• TB infection is highly associated with poverty and marginalisation, common to many PWID populations

3

Infections for which persons who inject

drugs may be at increased risk

HIV infection;

hepatitis A;

hepatitis B (HBV);

hepatitis C (HCV);

hepatitis D;

tuberculosis (TB)

skin and soft tissue infections caused by

Staphylococcus aureus (including methicillin-

resistant Staphylococcus aureus, MRSA) and

streptococcal infections (e.g. endocarditis,

necrotising fasciitis);

severe systemic sepsis (e.g. infections with

Clostridium novyi, Bacillus anthracis);

STIs other than HIV infection or hepatitis (e.g.

chlamydia infection, syphilis and gonorrhoea);

respiratory infections such as pneumonia,

diphtheria and influenza;

wound botulism;

tetanus;

human T-cell lymphotropic virus (HTLV)

infections.

4

Rate /

100 000 population

20 to 49

10 to 19

5 to 9

< 5

≥ 50

> 5

3 to <5 1 to <3

< 1

Rate / 100 000

population

5 to 9.9%

1 to 4.9%

≥10%

< 1%

HIV

TB

HIV+TB

Geographic concentration of blood-borne infections and TB among PWID

Purpose of the action

• To stop (eradicate) transmission of blood-borne and poverty related infectious diseases among people who inject drugs (PWID) in the EU

• By implementing country-tailored preventive interventions, using well tried evidence based harm reduction approaches

• Creating sustained, improved capacity of all EU countries to respond to infection risks and vulnerabilities among (PWID)

• With a specific focus on Latvia, Lithuania and Hungary, but engaging all partner countries


EU Priority groups

Comprehensive prevention

service package

Integrated, comprehensive public health service approach with an emphasis on capacity development


Coordi-

nation

Dissemi

nation

Evalu-

ation

Selected

partner

countries for

capacity

development

Direct support

from the project

funds

Partners with

exiting

comprehensive

services

packages and/or

experience in

overcoming

structural

barriers and

issues of

sustainability

EU Priority

Regions

Direct

support

Training

and bench-

marking

ECDC & EMCDDA joint guidance

– Comprehensive Guidance document

• Based on evidence and fully referenced

– Two part evidence assessment

1. Needle and syringe programmes and other interventions for preventing hepatitis C, HIV and injecting risk behaviour

2. Drug treatment for preventing hepatitis C, HIV and injecting risk behaviour

7

Seven interventions,

one aim: no

infections

Seven key recommended interventions

• INJECTION EQUIPMENT: Provision of and legal access to clean drug injection equipment, including sufficient supply of sterile needles and syringes, free of charge, as part of a combined multi-component approach, implemented through harm-reduction, counselling and treatment programmes

• VACCINATION: hepatitis A and B, tetanus, influenza vaccines, and, in particular for HIV-positive individuals, pneumococcal vaccine

• DRUG DEPENDENCE TREATMENT: Opioid substitution treatment and other effective forms of drug treatment

• TESTING: Voluntary diagnostic testing with informed consent for HIV, HCV, (HBV for unvaccinated) and other infections including TB should be routinely offered and linked to referral to treatment

8

INFECTIOUS DISEASE TREATMENT: Antiviral treatment based on clinical indications for those who are HIV, HBV or HCV-infected. Anti-tuberculosis treatment for active TB cases. TB prophylactic therapy should be considered for latent TB cases.

HEALTH PROMOTION: health promotion focused on safer injecting behaviour; sexual health including condom use; and disease prevention, testing and treatment

TARGETED DELIVERY OF SERVICES: Services should be combined and organised and delivered according to user needs and local conditions; this includes the provision of services through fixed sites offering drug treatment, harm reduction, counselling and testing, and referrals to general primary health and specialist medical services.

COMBINE THESE KEY INTERVENTIONS TO ENHANCE PREVENTION SYNERGY AND EFFECTIVENESS

• Ensure confidentiality.

• Promote service accessibility.

• Create a user-friendly atmosphere.

• Engage in dialogue with users and

promote peer involvement.

• Adopt a practical approach to the

provision of services.

• Refrain from ideological and moral

judgement.

• Maintain a realistic hierarchy of goals.

Core values of prevention of infections among people who inject drugs

A pragmatic approach to health promotion

The clients’ rights perspective

Public health objectives Guidance based on scientific evidence and expert experience

Principles of prevention

9.4.2015 10

Correlation of service increase and annually reported cases of HIV infection

0

1 000 000

2 000 000

3 000 000

4 000 000

0

20

40

60

80

100

Equipment exchanged

Annually rate

Focusing the action: use of ECDC and EMCDDA objective selection criteria


AT BE BG HR CY CZ DK EE FI FR DE EL HU IS IE IT LV LT LU MT NL NO PL PT RO SK SI ES SE UK

HIV trendHIV case reports and prevalence

(15% weight; no increase in case

reports or prevalence=0;

increase in one=1; increase in

both=2; high without an

increase=1)

0 0 2 0 0 0 0 1 0 0 0 1 0 0 0 0 2 1 0 0 0 0 0 0 2 0 0 0 0 0

Transmission riskprevalence of injecting drug use,

changes in injecting risk

behaviour (HCV prevalence and

trends) (10% weight; no

changes=0; moderate increase

in one criteria=1; increase in >1

criteria=2)

0 0 2 0 1 2 0 2 2 2 0 0 0 2 0 0 0 0

OST coverage% estimated problem opiate

user population receiving OST

(cut-off 30%) (25% weight; OST

coverage >30%=0; no data=1;

OST coverage <30%=2)

0 1 1 0 0 0 1 1 1 0 0 0 2 1 0 0 2 2 0 0 0 0 2 1 1 2 0 0 1 0

NSP coverageNumber of syringes given out

per PWID per year (cut-off 100

syringes) (25% weight; NSP

coverage >100=0; no data=1;

NSP coverage<100=2)

1 2 1 0 2 0 1 0 0 1 1 2 2 1 1 1 2 1 0 1 1 0 1 1 2 2 1 0 1 1

Taking part in the Joint Action x x x x x x x x x x x x x x x x x x x x

Scores (maximum 2)0,3 0,8 1 0 0,6 0 0,5 0,6 0,3 0,3 0,3 0,9 1,2 0,5 0,3 0,3 1,5 0,9 0 0,3 0,3 0 0,8 0,5 1,3 1 0,3 0 0,5 0,3

Ranking of those participating in

the JA (1=greatest

need/opportunity to improve

harm reduction situation) 6 3 8 5 2 1 4 6NO ALERT – no evidence for increase in case reports or HIV/HCV prevalence and/or transmission risk and/or low intervention coverage

CONCERN - Subnational increase in HIV/HCV prevalence and/or transmission risk or consistent but non-significant rise at national level.

ALERT – evidence for significant increase in case reports or HIV/HCV prevalence and/or increase in transmission risk and/or low intervention coverage.

Information unknown/not reported to EMCDDA/ECDC.

Table 1: Indicators of HIV trend, transmission risk and prevention coverage

Structure of the Joint Action


HIV and co-infection prevention and treatment in priority regions

and priority groups in the European Union improved

Improved capacity of countries to respond

to HIV and co-infection risks and

vulnerabilities with specific focus on people

who inject drugs (PWID) in Latvia, Lithuania

and Hungary

0.

Management

of the Joint

action

1. Provision of

low threshold

services for

PWID

2. Harm

reduction and

continuity of care

for prisoners

3. Promotion of

quality of care

models for PWID

4. Programme

capacity of

countries

WP1

Coordination

WP2

Dissemination

WP3 Evaluation

WP4 Implement

early diagnosis

WP5 Scale up

harm reduction

WP6 Increase the

access to harm

reduction services

and continuity of

care for drug users

in prisons

WP7 Promotion

of quality of care

models to

increase access,

uptake and

quality of HIV,

HCV and TB

treatment.

WP8 Mapping

the barriers for

access and

quality delivery

of services

Support the

development of

sustainable

national HIV and

co-infection

programmes

Associated and affiliated partners: 24+2 from 19 countries

• Belgium (BE) Modus vivendi asbl

• Croatia (HR)

– Croatian institute of Public Health (HZJZ)

– Life Quality Improvement Organisation FLIGHT (LET)

• Czech Republic (CZ) National monitoring center for drugs and additions (NMS)

• Denmark (DK) Centre for Health and Infectious disease Research, Rigshospitalet University of Copenhafen (CHIP)

• Estonia (EE) National Institute for Health Development (NIHD)

• Finland (FI) National Institute for Health and Welfare (THL)

• Germany (DE)

– Zentrum fur interdisziplinare Suchtforschung der Universitat Hamburg (ZIS)

– Institut fur Suchtforschung (ISFF)

– Deutsche AIDS-Hilfe (DAH)

• Affiliated: Germany (DE) AIDS Action Europe (AAE)

• Greece (EL) Hellenic Center For Disease Control and Prevention (HCDCP)


• Hungary (HU)

– OEK (National Centre for Epidemiology) (Országos Epidemiológiai Központ)

– Office of the Chief Medical Officer (OCMO), (OTH, Országos Tisztifőorvosi Hivatal)

• Iceland (IS) Landspitali University Hospital

• Italy (IT) Istituto Nazionale Malattie Infettive (INMI)

• Latvia (LV) Center For Disease Prevention and Control of Latvia

• Lithuania (LT)

– Center For Communicable Diseases And Aids (ULAC)

– Vilnius Center For Addictive Disorder (VPLC)

• Luxembourg (LU) Directorate of Health (Ministry of Health) – Division of Health Inspection

• Malta (MT) Ministry for Energy and Health (MEH)

• Poland (PL) National AIDS Centre of the Ministry of Health (NAC Poland)

• Portugal (PT) Directorate-General of Health (DGS)

• Slovenia (SI) Association SKUC

• Spain (ES) Instituto de Salud Carlos III (ISCIII)

– Affiliated:Centro de Investigacion Biomedica end Red (CIBER)

Collaborating partners: 12 with an additional 4 countries and 2 EU agencies • Norway (NO) Norwegian Institute of

Public Health, Oslo

• Sweden (SE) Public Health Agency of Sweden, Stockholm

• United Kingdom (UK) Department of Health, London

• Cyprus (CY) Medical and Public Health Services of the Ministry of Health of the Republic of Cyprus

• Czech Republic (CZ):

– The Czech AIDS help Society (CSAP)

– The national institute of Public Health (SZU)

– Ministry of Health (MZ CR)

• Spain (ES) Coordinadora Estatal de VIH-SIDA (CESIDA)

• Belgium (BE) Free Clinic

• Lithuania (LT) Vilnius University

• EU Agencies

– European Centre for Disease Prevention and Control (ECDC)

– European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)


Thank you for your attention!


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