DCRs as facilitators for testing, prevention and treatment for HCV for PWID in the Czech Republic
Grantee
Project start
April 2023
Main applicant and principal investigator
Viktor Mravcik, MD, Assoc Prof, PhD; Head of Research and Education, Spolecnost Podane ruce o.p.s.
Deputy applicant
Barbara Janikova, BSc, MA, Head of Infections Research, Spolecnost Podane ruce o.p.s.
Background
An estimated 12,000 people who inject drugs are living with chronic hepatitis C (HCV) in the Czech Republic. Research has linked injection risk behaviour with transmission of blood-borne infections such as HCV, which continues to spread among people who inject drugs. A number of countries have implemented various harm reduction and prevention initiatives including drug consumption rooms (DCR), where people can inject drugs in a safe environment under the supervision of professional staff. In a study from 2016, two thirds of 49 DCRs which offered onsite HCV testing were able to test 80% of its clients, of whom 60% tested positive and were linked to treatment. In the Czech Republic, there are 100 low-threshold harm reduction programmes, but still no DCR.
Objective
The overall aim is to increase access to testing, prevention and treatment of HCV for people who inject drugs. The first DRC in the country will be established around mid-2023, offering sterile injection and other consumption materials, as well as testing for HIV, HCV and other blood-borne infections and linkage to treatment. The specific objective of this project is to conduct a study to assess the feasibility and effect of the DRC on achieving the overall aim of increasing testing, prevention and treatment of HCV. More specifically, the study will focus on the feasibility of setting up a DCR as well as the effect of the new DCR on injection risk behaviours, improvement of quality of life of the users, and the effect at community level.
Methods
The first part of the research will be to carry out a feasibility study, collecting information from both potential clients, community members and other stakeholders, before the DCR is set up. The feasibility study will cover: a suitable location, opening hours, client acceptance, community acceptance, needs and relevance of services offered, as well as legal barriers and how they can be overcome. To measure the effect of the DRC on the community, members of the general population will be randomly sampled. To measure the effect of the DRC on the target group, a total of 500 people who use drugs will be recruited using snowball sampling. Both quantitative and qualitative data will be collected through forms filled in by clients monthly when entering the DRC, and through interviews and focus group discussions. The data collected will cover the following topics: the type of services most used and accepted by clients, reasons for not seeking treatment, changes in risk behaviour of the clients, changes in physical and mental health of the clients, changes in social relations with peers and family members, changes in the quality of life of clients (incl. retention in treatment).
Output / impact
The study will provide country-specific evidence of the feasibility of establishing DCRs and of the effectiveness of DCRs in reducing transmission of HIV and HCV. It will also provide a better understanding of the needs, challenges and barriers for clients accessing testing and treatment services. Study results will be disseminated among key national and regional agencies with a view to revising national policies for management of HIV and co-infections among people who use drugs. The hope is to challenge existing views on tools to be included in national harm reduction programmes by demonstrating the effectiveness of DCRs. Expansion of DCRs is expected to have a considerable impact on reduction of the spread of HIV and HCV.