By International Network of Drug Consumption Rooms
Drug consumption rooms (DCRs) and supervised injecting facilities (SIFs) target the most vulnerable people who use drugs (PWUD) – particularly people who use opioids, people who inject drugs (PWID), people who use drugs heavily1 or high-risk drug users (HRDI)2 . While decreases in risky injecting behaviours are an outcome of DCR use, HCV prevention and treatment in these settings haven’t been adequately described. There are no international DCR standards for HCV practice and surveys are yet to address HCV prevention, treatment or sero-prevalence status of DCR clients. This online survey provides a ‘snapshot’ of DCR clients’ HCV status; approaches to HCV in DCRs, and what DCRs need to expand these services.
Fifty-one responses were collected from representatives of the 92 operating DCRs in Australia, Canada, Denmark, France, Germany, Luxembourg, Netherlands, Norway, Spain and Switzerland participated in the survey; thus over half of the DCRs were directly represented (55 %) and several respondents had filled the survey on behalf of several DCR’s within their organisation. All countries where DCRs are operated were represented.
An estimated mean 71% of SIF/DCR clients had been tested for HCV and about 58% were HCV positive. Most DCRs provided HCV testing onsite (67%); of these majority tested via blood samples (65%) and several used finger prick (31%) or saliva (31%). Several DCRs referred to offsite HCV testing (75%). Only four European DRCs provided HCV treatment onsite at the time of the survey; twowere providing DAAs (“new treatment”) and two were providing both interferon and DAAs treatments. The majority of SIFs/DCRs referred clients offsite for treatment (96%). Several offered disease self-management support (50%) or monitoring liver health (24%). Overall, DCRs reported that HCV support (94%), new treatments (92%) or treatment with interferon (50%) were available for their clients at other services.
To provide further HCV-related services, DCR indicated that they need more staff time (51%) and staff training (45%), that they would have to expand staff qualifications (30%) and that further funding for equipment and services would be needed (38%). A change in national HCV treatment guidelines for active drug users was also identified as a need (23%). When it comes any additional funding, the respondents indicated they would use it on employing additional medical staff (52%), develop client education (52%) or on additional staff training (46%).
DCR involvement in HCV prevention and treatment is crucial. SIFs/DCRs should to be supported to provide an entry point to HCV treatment as they are working on the frontline with the most marginalised PWID and are capable of removing barriers to HCV treatment in this population. Also, options for colocation of HCV services at DCRs or provision of HCV treatment onsite should be considered.