Good practice examples
AUSTRIA – Suchthilfe Wien
HCV-network; cooperation-with-pharmacies; ‘directly-observed-therapy’; ‘bring-your-friends’;
TEST; LINK; TREAT-ext; LTA; PWUD; NURSE; MULTI
Where – Services provided:
needle and syringe exchange; opioid substitution therapy (OST); drop-in centre; outreach/street-work; mobile unit; pharmacies; socio-economic support facilities.
Who – Target groups:
people who use drugs (PWUD); people who inject drugs (PWID); migrants (documented and undocumented); people experiencing homelessness.
How – Team composition:
social workers; nurses; medical doctors; hepatologists; art therapists; psychoanalysts; psychotherapists.
Suchthilfe Wien is a low-threshold service provider for people who use drugs (PWUD), based in Vienna, Austria. It has all the infrastructure needed to provide comprehensive care for this group: a day centre, an emergency shelter, a syringe exchange programme and an outpatient clinic with drug dependence specialists, psychiatrists, nurses, social workers, HIV specialists and hepatologists.
In order to succeed with the treatment of chronic hepatitis C among people who inject drugs (PWID), Suchthilfe Wien developed a new ‘therapy setting’. Clients are given the possibility of ingesting their OST medication together with their antiviral therapy at the same place and time. To implement this approach, the Wilhelminen Hospital and Suchthilfe Wien merged into a large hepatologic centre (the ‘Vienna HCV network’).
Awareness & Prevention
Clients visiting Suchthilfe Wien can benefit from hepatitis-related handout materials and other relevant information and clarifications during its opening hours. In addition, there are special events, such as ‘Liver Days’, which seek to raise awareness and to offer basic education to their clients.
The Staff has team meetings and education workshops and trainings to discuss new information and treatments.
Clients are briefed by a local team on the possibilities of HCV testing and, afterwards, about treatment options. Using an HCV antibody saliva test, they can determine a person’s HCV status on-the-spot. In the case of a positive HCV-AK test result, a blood test can be immediately undertaken.
The result is available in 60 minutes and an appointment is made for further clarification and subsequent treatment at the Wilhelminen Hospital or at the Suchthilfe Wien. Both facilities have dedicated staff for testing and pre- and post-test counselling.
Hepatitis B and C testing for staff is regularly available on-site at Suchthilfe Wien as well as hepatitis A and B vaccination.
Treatment & Care
With their ’directly observed therapy’ for chronic hepatitis C (patients receiving antiviral treatment together with OAT under direct observation of a pharmacist, physician or nurse on a daily basis) at a pharmacy or low-threshold institution, chronic hepatitis C can be cured within a group of difficult-to-treat patients who are unlikely to be successfully treated in other environments. For the ‘directly observed therapy’ of OAT and DDA, cooperation with pharmacies is very important. Currently, more than 50 pharmacies in Vienna and the surrounding areas are partners of the Vienna HCV network.
Patients are provided with pre- and post-test counselling in terms of a talk with a nurse or a medical doctor where they are informed before, during and after the therapy about safer drug use and prevention of reinfection. Patients can also benefit from disease self-management and liver health monitoring.
As part of the treatment, there is a ‘bring your friends’ policy. An attempt is made to persuade all patients to motivate, or bring along, their friends with whom they consume drugs.
Staff of Suchthilfe Wien need additional training, including educational materials. There is also a need to hire, train and support peer workers who, at present, are not properly incorporated within the programme. There is also a need for the medical sector in general to change its attitude towards the provision of services for people who use drugs.
The organisation believes that from a policy perspective, there would be great benefit from allowing general practitioners to prescribe treatment rather than only hepatologists.
Advocacy, Sustainability and Transferability
Suchthilfe Wien has sustainable and ongoing hepatitis-related activities with regular funding. The therapy, as well as the tests, are paid for by the respective health insurance companies (as part of the patient’s social insurance).
The screening programme can serve as a pioneering project for similar settings.
Due to the pioneering and successful role that the programme has had in the treatment of PWID under the ‘Vienna HCV network’, many similar treatment options for people who inject drugs with chronic hepatitis C have been created in Austria.
According to Suchthilfe Wien, the close cooperation of the two specialised institutions, Suchthilfe Wien (in the field of drug dependence) and the Wilhelminen Hospital, together with OST, considerably increases adherence to therapy and is considered to be a relevant factor for the treatment of an otherwise non-participative treatment group. Thus, it is recommended to implement a similar system in other countries.
Austria – Suchthilfe Wien
Address: Gumpendorfer Gürtel 8
Tel.: +43 (0)1 4000 53 600
Fax.: +43 (0)1 4000 53 699
c/o De Regenboog Groep
European Harm Reduction
1013 GE Amsterdam
tel. +31 20 570 7829
fax.+31 20 420 3528
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