HA-REACT Joint Action on HIV and coinfection. prevention and harm reduction

Transcription

1 HA-REACT Joint Action on HIV and coinfection prevention and harm reduction 3 rd EU Health Programme Call: HP-JA-2014, Topic: JA Mika Salminen/Outi Karvonen 1

2 A proposal for a Joint Action project under the EU Health Programme 2014 call Addresses Annual Work Programme, subheading 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, and its [SWD(2014)106] action plan extension Mika Salminen/Outi Karvonen 2

3 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 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 methicillinresistant 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. 3

4 Geographic concentration of blood-borne infections and TB among PWID Rate / population < 1 1 to <3 3 to <5 > 5 HIV Rate / population < 5 5 to 9 10 to to TB < 1% HIV+TB 1 to 4.9% 5 to 9.9% 10% 4

5 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 Mika Salminen/Outi Karvonen 5

6 Integrated, comprehensive public health service approach with an emphasis on capacity development EU Priority groups Dissemi nation Coordination Evaluation Comprehensive prevention service package Partners with exiting comprehensive services packages and/or experience in overcoming structural barriers and issues of sustainability Training and benchmarking Direct support Selected partner countries for capacity development Direct support from the project funds EU Priority Regions Mika Salminen/Outi Karvonen 6

7 ECDC & EMCDDA joint guidance Seven interventions, one aim: no infections 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

8 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 harmreduction, counselling and treatment programmes VACCINATION: hepatitis A and B, tetanus, influenza vaccines, and, in particular for HIVpositive 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 COMBINE THESE KEY INTERVENTIONS TO ENHANCE PREVENTION SYNERGY AND EFFECTIVENESS INFECTIOUS DISEASE TREATMENT: Antiviral treatment based on clinical indications for those who are HIV, HBV or HCV-infected. Antituberculosis 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.

9 Core values of prevention of infections among people who inject drugs 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. A pragmatic approach to health The clients rights perspective promotion Principles of prevention Public health objectives Guidance based on scientific evidence and expert experience

10 Correlation of service increase and annually reported cases of HIV infection 100 Annually rate Equipment exchanged

11 Focusing the action: use of ECDC and EMCDDA objective selection criteria HIV trend HIV 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) Table 1: Indicators of HIV trend, transmission risk and prevention coverage 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 Transmission risk prevalence 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) 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) NSP coverage Number 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) 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, ,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) NO 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 Mika Salminen/Outi Karvonen 11

12 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 Mika Salminen/Outi Karvonen 12

13 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) Mika Salminen/Outi Karvonen 13

14 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) Mika Salminen/Outi Karvonen 14

15 Thank you for your attention! Mika Salminen/Outi Karvonen 15