Improving Access to Test and Counselling Services for Injection Drug Users: Most Recent Experience from Portugal. Henrique Barros

Transcription

1 Improving Access to Test and Counselling Services for Injection Drug Users: Most Recent Experience from Portugal Henrique Barros Ministério da Saúde

2 HIV Testing Knowledge of HIV serostatus has been increasingly advocated as a prevention measure in its own right.

3 Most commonly stated barriers to HIV testing: being aware of a negative test a preference not to know perception of low risk for HIV concerns about losing employment and life assurance.

4 HIV Testing AIDS programmes need to be able to make comparisons about what works and doesn t work; and to estimate the resources required at country, regional, and global levels to provide universal access to HIV prevention services

5 HIV Testing Rapid point-of-care HIV testing is a very important component of HIV control initiatives and programs. Non-invasive, simple, accurate (blood or oral fluid-based) rapid tests have the potential to make a big impact on HIV screening programs, especially in areas where laboratory infrastructure is poor or unavailable

6 HIV Testing

7 HIV and Drug Users Over the past decade, a body of observational research has accumulated about the effects of outreach-based and peer added HIV interventions for drug users.

8 HIV and Drug Users Chen et al. AIDS Behav, 26

9 HIV and Drug Users Drug Users in Portugal 3, clients contact the public health and social services for drug users; Approximately 15, DUs are reached by harm reduction structures.

10 AIDS Cases - Portugal Date of diagnosis Date of declaration

11 HIV and Drug Users HIV Notifications UDIs HS MSM MTCT

12 HIV and Drug Users AIDS Notifications 55, 412,5 275, 137,5, IDUs HS MSM MTCT

13 HIV new infections in IDUs (per 1,, population) NA NA NA NA

14 HIV/AIDS patients on HAART (26), by region ARS Norte ARS Centro ARS LVT ARS Alentejo ARS Algarve

15 Distance from usual residence to hospital

16 n Modes of Transmission HSJ, Tx, Hemof MSM Heterosexual IDUs

17 HIV and Drug Users Programs for Injection Drug Users: Needle and syringe exchange Substitution therapy Medically assisted injection facilities

18 HIV and Drug Users Syringe Exchange Kit

19 HIV and Drug Users syringes Pharmacies Partnerships protocols w ith NGO Mobile Units

20 HIV and Drug Users - Portugal Modelling of the effect of the Needle Exchange Programme on HIV prevalence among IDUs. NO YES

21 Survey of two Portuguese Prisons HIV prevalence according to lifetime drug use. Men Women n HIV + n HIV + None 64 1 (1.6%) (6.7%) Only cannabis 51 1 (2.%) 72 4 (5.6%) Only heroin 1 (.%) 1 (.%) Only cocaine 3 (.%) 7 (.%) Only other drugs* 1 (.%) 2 (.%) Cannabis+heroin - 1 (.%) Cannabis+cocaine 16 (.%) 27 2 (7.4%) Cannabis+other drugs* 18 (.%) 6 (.%) Cannabis+heroin+cocaine 24 9 (37.5%) 18 5 (27.8%) Cannabis+heroin+other drugs* - - Cannabis+cocaine+other drugs* 19 (.%) 15 (.%) Heroin+cocaine 1 (.%) - Heroin+other drugs* - 1 (.%) Cocaine+ other drugs * 1 (.%) - Heroin+cocaine+ other drugs * - - Cannabis+heroin+cocaine+ other drugs * (25.5%) (38.5%)

22 Survey of two Portuguese Prisons Prevalence of infection according to IDU and sharing of injection material in men. n HIV HBV HCV Syphilis Chlamydia n (%) n (%) n (%) n (%) n (%) Overall (8.9) 5 (1.9) 59 (21.8) 6 (2.2) 19 (6.) Never used injected drugs (1.) 1 (.5) 7 (3.5) 3 (1.5) 19 (8.1) Used injected drugs/never shared injection material 23 6 (26.1) 1 (4.4) 21 (91.3) (.) (.) Used injected drugs/ever shared injection material (5.) 1 (3.1) 3 (93.8) 1 (3.1) (.) Prevalence of infection according to IDU and sharing of injection material in women. n HIV HBV HCV Syphilis Chlamydia n (%) n (%) n (%) n (%) n (%) Overall (9.9) 9 (2.) 51 (11.5) 16 (3.6) 5 (1.) Never used injected drugs (5.7) 6 (1.6) 13 (3.5) 11 (3.) 4 (1.) Used injected drugs/never shared injection material 17 4 (23.5) 1 (5.9) 9 (52.9) 1 (5.9) (.) Used injected drugs/ever shared injection material (57.1) 1 (3.6) 22 (78.6) 2 (7.1) 1 (3.2)

23 Survey of two Portuguese Prisons Men Non IDUs IDUs never sharers IDUs ever sharers n HIV HCV HIV/HCV (1.) 6 (26.1) 16 (5.) 7 (3.5) 21 (91.3) 3 (93.8) (.) 6 (26.1) 16 (5.) p <.1 <.1 <.1 Women Non IDUs IDUs never sharers IDUs ever sharers (5.7) 4 (23.5) 16 (57.1) 13 (3.5) 9 (52.9) 22 (78.6) 5 (1.4) 2 (11.7) 14 (5.) p <.1 <.1 <.1

24 HIV and Drug Users Drug treatment public services [1] Public Detoxification Units 23 % 24 % 23 % 24 % First-time clients Clients HIV testing , , HIV testing , ,6 HIV , ,2 HIV , ,7 ARV treatment 62 4,3 27 2,3 ARV treatment 98 5,4 71 4,3 Certified Detoxification Units 23 % 24 % Clients HIV testing , ,9 HIV , ,4 ARV treatment 8 8,4 63 5,3 [1] IDT. Relatório Anual. 23 A Situação do País e Matérias de Drogas e Toxicodependências. Vol.I Informação Estatística.23. IDT. Relatório Anual. 24 A Situação do País e Matérias de Drogas e Toxicodependências. Vol.I Informação Estatística.24

25 UD 1st visit (1) Evaluation UD Active (2) screening N&Psy Information + questionnaire Usual Situation (3) Pre-test counselling N&Psy TEST (+) TEST (-) (4) Test N&Psy MEDICAL DOCTOR 5(VIH+) Post-test counselling N&Psy (6) Test confirmation (7+) Post-test counselling N&Psy 5(VIH-) Post-test counselling N&Psy 7(VIH-) Post-test counselling N&Psy (8) Referal Or Social worker Discussion about options (9) Hospitalar (1) Social work services

26 HIV and Drug Users Portuguese Programme

27 HIV and Drug Users Portuguese Programme

28 HIV and Drug Users Portuguese Programme

29 HIV and Drug Users Portuguese Programme

30 HIV and Drug Users Portuguese Programme

31 HIV and Drug Users Portuguese Programme

32 HIV and Drug Users Portuguese Programme Norte 13 CAT Centro 11 CAT LVT 15 CAT Alentejo 4 CAT Algarve 2 CAT

33 HIV and Drug Users (Rapid tests)

34 National Survey of IDUs Pilot test results IDU Never Ever Injection material sharing Never Ever First visit Never IDU Ever IDU n HIV+ p (.%) 14 (4.3%) 3 (2.3%) 11 (6.2%) (.%) 2 (5.3%)

35 HIV and Drug Users

36 The AIDS epidemic is not only about revealing injustice, but also about overcoming injustice. Peter Piot, February 27