Theme: Epidemiology & Public Health Research Year: 2018
People who inject drugs (PWID) remain a key risk group for hepatitis C virus (HCV) with
national prevalence estimates ranging from 13.8% (Malta) to 84.3% (Portugal) in Europe.
Eliminating HCV requires testing and treatment of PWID at larger scale. To address this, an
initiative to promote HCV testing in drug treatment settings across Europe is piloted by the
European Monitoring Centre for Drugs and Drug Addiction (EMCDDA).
As part of a diagnostic process a checklist to identify barriers of HCV testing for PWID was
developed by the Robert Koch-Institute. Barriers identified during a brainstorming exercise
with experts were categorised in three levels, and completed through a literature search
(PubMed; Google Scholar) and websites of EU projects.
System level barriers include: laws preventing lay workers from providing testing; systems
that allow data exchange and thereby risk breach of confidentiality; lack of funding; and
clinical guidelines that exclude active PWID from eligibility for treatment. Some system
barriers are inextricably linked and determine the way testing and linkage to care are
Provider level barriers include: lack of knowledge and confidence in offering testing; health
counselling not perceived as responsibility of staff in drug treatment services; too few staff
members; lack of collaboration with laboratories; and unclear referral pathways.
Client level barriers include: lack of knowledge on HCV; restricted access to testing, due to
distance or opening hours of testing sites; fear of stigma; not getting treatment; treatment
side-effects; losing custody of children or being deported.
Identifying and tackling barriers and stigma is key in increasing access to HCV testing for
PWID. Removal of some barriers may require changes to wider national health and legal
systems, while others can be solved by implementing simple regulations or change in
practice and by increasing knowledge among staff and clients.
No Conflicts of Interest