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Guidelines for testing HIV, viral hepatitis and other infections in injecting drug users
A manual for provider-initiated medical examination,
testing and counselling
EMCDDA, Lisbon, November/December 2010, Source: European Monitoring Centre for Drugs and Drug Addiction
EMCDDA: European Monitoring Centre for Drugs and Drug Addiction ...
Aims to provide reliable information on drugs and drug addiction in the EU. Provides online reports databases about drug usage and anti-drug programs. www.emcdda.europa.eu/
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The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) was established in 1993. Inaugurated in Lisbon in 1995, it is one of the EU's decentralised agencies.
The EMCDDA exists to provide the EU and its Member States with a factual overview of European drug problems and a solid evidence base to support the drugs debate. Today it offers policymakers the data they need for drawing up informed drug laws and strategies. It also helps professionals and practitioners working in the field pinpoint best practice and new areas of research.
"The EMCDDA estimates that 30Ð50% of HIV positive IDUs in Europe are unaware of being infected. It also estimates that around 50% of IDUs (varying between countries from 10% to 90%) are infected with viral hepatitis (notably hepatitis C), which can lead to severe liver disease and premature death."
More injecting drug users should undergo tests for HIV, viral hepatitis and other infections such as tuberculosis, says the EU drugs agency (EMCDDA). In new guidelines published today on the eve of World AIDS Day, the agency describes how, in this group, the uptake of testing is still low in many European countries (1).
Infectious diseases are among the most serious health consequences of injecting drug use and can lead to significant healthcare costs. The new guidelines recommend a strategy to increase testing uptake, both in Europe and beyond, that would ensure earlier treatment for injecting drug users (IDUs) and would lower the risk of infection spreading to the wider population.
IDUs are vulnerable to a range of infectious diseases due to a variety of risk behaviours and underlying conditions, such as poor hygiene, homelessness and poverty. The EMCDDA estimates that 30Ð50% of HIV positive IDUs in Europe are unaware of being infected. It also estimates that around 50% of IDUs (varying between countries from 10% to 90%) are infected with viral hepatitis (notably hepatitis C), which can lead to severe liver disease and premature death.
Commenting today, EMCDDA Director Wolfgang Gštz said: 'It is crucial that those infected are aware of their condition so that they can protect their partners and access the appropriate care and treatment. We encourage service providers and healthcare professionals to take a more proactive approach and ensure that clients at the highest risk of contracting drug-related infections are offered testing on a regular basis. Until now, timely diagnosis and treatment of infectious diseases has often been too low a priority among professionals in contact with drug users'.
Today's manual provides guidance at a practical level, proposing a series of standard tests to be undertaken regularly on a voluntary and informed basis. Among these are serology tests for HIV, hepatitis (A, B, C, D) and other sexually transmitted infections; general blood tests; and tests for tuberculosis. For high-risk IDUs, these tests should be considered annually, or even bi-annually. The guidelines also offer a package of prevention, primary care and referral routines in relation to IDUs and infections.
The guidelines recommend that health providers initiate examination, testing and counselling in IDUs in a variety of healthcare settings (e.g. primary healthcare; special health services for IDUs; low-threshold service centres visited by IDUs; rehabilitation centres; dedicated sexually transmitted infections clinics and prison healthcare facilities). Developed in collaboration with European experts on drug-related infectious diseases, the guidelines are now being distributed across the European Union and globally. They are intended to be of use to thousands of service providers, and may potentially benefit hundreds of thousands of IDUs.
Summary:
Infectious diseases are among the most serious health consequences of injecting drug use and can lead to significant healthcare costs. Injecting drug users are vulnerable to a range of infectious and communicable diseases through a variety of risk behaviours, and because of underlying conditions such as poor hygiene, homelessness and poverty. There is a recognised need for guidance on providing IDUs with a medical examination and testing for HIV, viral hepatitis and several other infections on a regular basis. In addition, improving testing uptake in this group would benefit epidemiological surveillance and monitoring as carried out at the national and international level.
These guidelines are accompanied by a recommended package of prevention and primary care in relation to injecting drug users and infections. Treatment and other specialist care are not discussed in detail but are dealt with by indicating referral to appropriate services.
A thorough medical examination, testing and counselling of IDUs should include:
testing for infections;
post-test counselling;
prevention counselling;
Basic recommended tests
The tests that should be included in a standard offer to all IDUs in provider-initiated routine
medical examinations are-
Serology testing for:
· HIV
· hepatitis A
· hepatitis B
· hepatitis C
· hepatitis D (if evidence of chronic or recent hepatitis B);
· syphilis.
Hepatitis C
When to refer: All IDUs with a positive antibody test and a positive PCR should be followed up by a repeated test after three to six months, and if the test is still positive, should be considered for eradication therapy. Liver function status is important in the evaluation of the need for medication therapy.
Specific guidelines exist for the treatment of hepatitis C at national and European level (Hepatol, 1999). It is important to note that although some guidelines still exclude active IDUs or IDUs on opioid substitution treatment from viral treatment, study results indicate that IDUs can be successfully treated and may avoid reinfection (Hepatol, 1999; Reimer et al., 2005).
Training and ongoing supervision and monitoring of healthcare providers carrying out routine medical examination, testing and counselling with IDUs is required for the successful implementation of the service. Training programmes for personnel should be developed
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