BOOSTING LIVER HEALTH
The BOOST project, launched in 2023 with 13 partners, is aligned with Sustainable Development Goal 3.3, which advocates for the reduction of the burden of communicable diseases, including viral hepatitis, which is well known to greatly impact the liver (1).
Harm reduction (HR) strategies are designed to reduce the health, social, and economic burden associated with drug use. (2). It is important to note that due to risk factors, such as unsafe drug use like needle sharing, people who use drugs are at a higher risk of contracting infectious diseases including HIV, viral hepatitis B and (HBV) and C (HCV)), and sexually transmitted infections (STIs) (2). Specifically, HBV and HCV are considered public health threats and major risk factors for the development of chronic liver diseases and liver cancer, particularly hepatocellular carcinoma (HCC), increasing the health risks for people who use drugs (3). While the prevalence of HBV in Europe is low due to high childhood vaccination coverage, it is estimated that 10% of people who inject drugs live with HBV, which is a major health risk to this group (4). As for HCV, in 2021, there were 14,560 new cases reported in the European Union (EU) and the European Economic Area (EEA) (5). Additionally, it was estimated that 35.8% of EU/EEA cases were related to drug injection (6).
Harm reduction interventions and services are essential to preventing HBV and HCV and to reduce the risk of contraction and spread of disease and infections. Accordingly, the BOOST project contributes to addressing the risks associated to increased liver-associated infections:
Upscale of testing in lighthouses and mentees: Lighthouses are highly experienced organizations which play a crucial role in boosting the implementation of community-based interventions and good practices, and provide support through training and mentorship to other organizations. BOOST is dedicated to building capacity and cultivating good practices among community-based/-led organisations. It supports the upscale of community-based testing services (e.g., using rapid diagnostic tests for viral hepatitis), and linkage to treatment, while also training these organisations on good practices for the prevention and the development of communicable disease management plans.
Use of COBATEST tool to improve data collection and follow up of users being tested: BOOST has led the adaptation of COBATEST, a data collection tool for information on risk behaviours, HIV, syphilis and HCV testing, to be used in HR settings. The adaptation has consisted in the inclusion of additional questions relevant to HR services and their attendants, such as data collection on HBV, and other STIs (e.g., gonorrhoea and chlamydia). The COBATEST tool allows for the collection of reliable data which can support quality planning and management of HR services.
Advocacy to promote consumption rooms and needle exchange programs: BOOST strongly advocates for improved and accessible community-based harm reduction services across Europe. By advocating and supporting HR services, such as needle and syringe exchange programs, BOOST directly contributes to the prevention of communicable diseases transmission, such as viral hepatitis. In these programs, sterile needles are provided to users to prevent needle-sharing, and a place is provided for their safe disposal. Further, BOOST also supports supervised consumption rooms as strategic points for implementing screening interventions of communicable diseases, including viral hepatitis, such as through the use of rapid tests.
In conclusion, viral hepatitis remain a public health challenge in Europe, and particularly among people who use drugs, which are disproportionally affected by these infections. Moreover, the economic and social burden associated with viral hepatitis infections is significant. Therefore, in the BOOST project, we advocate for the uptake of community-based harm reduction services which not only reduce the stigma associated with drug consumption, but also contribute to the prevention and addresses communicable diseases such as HBV and HCV, promoting increased liver health for all.
References:
- United Nations. United Nations Sustainable Development. [Accessed April 2024]. Available at: https://www.un.org/sustainabledevelopment/
- European Monitoring Centre for Drugs and Drug Addiction. Harm reduction – the current situation in Europe (European Drug Report 2023). 2023. 31084_en.pdf [Internet]. Available at: https://www.emcdda.europa.eu/sites/default/files/pdf/31084_en.pdf?46227
- Toh MR, Wong EYT, Wong SH, Ng AWT, Loo LH, Chow PKH, et al. Global Epidemiology and Genetics of Hepatocellular Carcinoma. Gastroenterology. 2023;164(5):766-82. Available at: https://www.gastrojournal.org/article/S0016-5085(23)00105-1/fulltext?referrer=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F
- European Monitoring Centre for Drugs and Drug Addiction. European drug report 2023. LU: Publications Office. 2023. Available at: https://data.europa.eu/doi/10.2810/161905
- European Centre for Disease Control (ECDC). Surveillance Atlas of Infectious Diseases. [Accessed April 2024]. Available at: https://atlas.ecdc.europa.eu/public/index.aspx
- Thomadakis C, Gountas I, Duffell E, Gountas K, Bluemel B, Seyler T, et al. Prevalence of chronic HCV infection in EU/EEA countries in 2019 using multiparameter evidence synthesis. Lancet Reg Health Eur. 2024;36:100792. Available at: https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(23)00211-9/fulltext
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