_ To help understand the results of the REDUCE project, we have provided background information on hepatitis C among drug users in each of the countries participating in the project.

Country
Spain
Scotland
Poland
Austria
Italy
Population
 49,000,000
 5,222,100
(June 2010)
 38,482,919
 8,400,000
 60,700,000






Prevalence of hepatitis C (%)
 2.5%
1%
(50,000/5,000,000)
 0.4%-1.9%
 0.5%-1%
 3%-12%






Prevalence of hepatitis C among drug users/ IDUs (%)
65% - 90%
57%
47.6%
38%-73%
61%






Prevalence of hepatitis C among female drug users/ IDUs (%)
54% -71%
57%
75.8%
38%-79%
63.8%






Incident hepatitis C infections (%)
In IDUS:
34.8/100 subject/year
CI 95%: 26- 46/100
9.5 per 100 person years
5.08 per 100 000
Not known
Not known






Usual treatment for substance abuse (describe)
Public Health System Drug Abuse network (out patient centres, detoxification units, therapeutic communities) Treatment: pharmacological and psychosocial Harm reduction facilities and programs
Drug treatment is mostly provided on an out-patient basis. Treatments include substitute prescribing; psycho-social interventions; residential rehabilitation; harm reduction services and crisis intervention services.
The Polish drug treatment system is organized on the basis of: outpatient units, detoxification units, day-care units, hospital units, rehabilitation centers, treatment units in prisons, harm reduction programmes. Therapy is provided free. Residential treatment, is the most prevalent model, based on the therapeutic community approach, where abstinence is a main goal and treatment lasts 6-12 months or longer.
Drug treatment is mostly provided on an outpatient basis: Counseling centers for users of licit and illicit drugs and specialized treatment or reintegration facilities for clients dependent on illicit substances. Detoxification treatment is primarily carried out in inpatient facilities, but increasingly also in outpatient settings. Opioid maintenance is widely available (public health authorities, hospitals, prisons, general practitioners), covering all types of substances (Methadon, Buprenorphine, Buprenorphine/Naloxone, slow-realease Morphines, Polamidon) and there is also provided a treatment adopted for pregnant women.
Pharmacological and psychological-biological-sociological support from the SERT (national substance addiction services for prevention and treatment). Services dedicated to substance abuse must employ an adequate number of professionals to carry out activities related to prevention, treatment and rehabilitation and coordinate the treatments related to +ve in drug users, also in collaboration with Family Services. They can adopt cessation methods, as well as adequate pharmacological and psychological and sociological treatments within their treatment plans Any type of treatment program should include the resolution of health, social, education, and legal issues.
Are the following treatments provided to substance abusers

1) pharmacotherapy (e.g. methadone maintenance, antabuse) (yes/no)
2) counselling (e.g. outpatient individual or group) (yes/no)
3) residential treatment (e.g. inpatient rehabilitation centres) (yes/no)
4) outpatient detoxification (yes/no)
5) inpatient detoxification (yes/no)
6) self help (e.g. AA/NA) (yes/no)




1) yes



2) yes


3) yes



4) yes

5) yes

6) yes




1) yes



2) yes


3) yes



4) yes

5) yes

6) yes




1) yes



2) yes


3) yes



4) yes (private sector)

5) yes

6) yes




1) yes



2) yes


3) yes



4) yes

5) yes

6) yes




1) yes



2) yes


3) yes



4) yes

5) yes

6) yes
Methadone maintenance available (Yes/no)
If yes:
- year of treatment introduced
- % of target group covered
- currently available free of charge (yes/no)
- there is waiting list (yes/no)
- if yes, estimated waiting time (days)
yes



1985, but more widely available from 1991
65%

yes

no

N/A
yes



1986

Unsure

yes

no
yes



1992

unknown

yes

yes

Availability varies in different provinces, the best situation is in Warsaw where there are three public and two private methadone maintenance programmes. There are some regions with no access to methadone maintenance.
yes



1987

25%

yes

no

N/A
yes



1980

66,3%

yes

no

N/A
Needle exchanges available
(Yes/no)
If yes:
- year of introduction
- currently available free of charge (yes/no)
yes



1988
yes
yes



1986
yes
yes



1989
yes
yes



1990
yes
yes



1999
yes
Injecting rooms available
(Yes/no)
If yes:
- year of introduction
- currently available free of charge (yes/no)
yes



2000
Yes
No



N/A
N/A
No



N/A
N/A
No



N/A
N/A
No



N/A
N/A
Psychosocial interventions available to reduce risk behaviours (describe; do women specific projects exist)
Education is offered to reduce risk behaviour in outreach programs and treatment centres, including harm reduction centres. There are no specific interventions for women.
Psycho-social interventions available from addiction treatment services.

Some services provide women specific interventions.
Education is offered to reduce risk behaviour. There are specific interventions for pregnant women
Healthcare professionals from different disciplines are available (inpatient or outpatient): Social workers, clinical psychologists and psychotherapists.

Outpatient psychosocial interventions focus on counseling, outreach work, psychotherapy, aftercare and reintegration programs. Inpatient psychosocial interventions are provided in specific, as well as in generic facilities, offering long-term and short-term treatment, often together with inpatient detoxification. Moreover organizations specialized on women are available as well (e.g. for victims of violence in relationships, pregnant women).
XX
Hepatitis C treatment available to drug users (yes/no)
If yes:
- describe any special circumstances, e.g. drug free for a certain period of time; no longer eligible if returns to injecting drug use)


























- currently available free of charge (yes/no)
- waiting list (yes/no)
-if yes, estimated waiting time (days)
Yes,

Drug free for last 6 months (including alcohol and illicit drugs) Substitution treatment including methadone or buprenorphine is allowed.




























Yes

No waiting list
Yes

Currently, there is no requirement to be drug free. However, patients must be stable and considered able to adhere to treatment.





























yes

yes

Yes, but no unit or project specifically targeting drug users. To receive treatment, drug users should be drug free or in methadone maintenance treatment and must meet the medical criteria. If patients return to injecting drug use, they are no longer eligible for therapy. If drug use ceases, the patient will be re-evaluated and a decision about whether to return to treatment is made.



















yes

yes
Waiting times vary from 2 weeks to 3 months. The best situation is in Warsaw.

Patients after successful detoxification and/or patients in opioid maintenance therapy may receive antiviral treatment. Patients are eligible for treatment after at least 6 months of abstinence or, in case of substitution treatment, without additional drug use or, in case of drug use, no injection drug use or intoxication and few psychosocial deficits. Antiviral treatment is contraindicated for patients with periodically or continuously uncontrolled drug use or with injection drug use without applying safer-use criteria. Patients undergoing maintenance treatment who follow safer-use criteria when injecting intravenously or injecting drug users are possibly eligible for treatment. Decisions are based on individual patients after analyzing risks and benefits.

yes

no
N/A
Yes, treatment is normally given in cooperation with the Infection Disease Unit in the hospitals. The SERTs provide psychological, biological, and sociological support. Both services cooperate in pursuing the complete treatment program. For some treatments the patient must be near the end of detoxification from methadone or equivalent substances, because of the low retention rate


















yes

no
N/A