Good practice examples
CZECHIA / CZECH REPUBLIC – Sananim
Mobile-unit-community-based-testing; peer-workers; no-need-for-abstinence; advocacy-on-access-to-treatment-and-against-stigma;
TEST; LINK; DTC; LTA; OUT; PWUD+; PEER; NURSE; MULTI;
Where – Services provided:
low-threshold drug services and counseling; opioid substitution therapy; drop-in centre; outreach/street-work; mobile unit; prison work; treatment; therapeutic communities; aftercare; OST; ambulances for work with families, partners, gamblers; social business enterprise; case management; online counselling.
Who – Target groups:
people who use drugs or inject drugs; sex workers; men-who-have-sex-with-men (MSM); people experiencing homelessness.
How – Team composition:
social workers; peer workers (paid); medical doctors; nurses; hepatologist; psychologist; psychotherapists; psychiatrist; addictologists.
Sananim is a harm reduction and treatment service provider established in 1990 after the ‘Velvet Revolution’ in Prague, Czechia (Czech Republic). From its start, the organisation has focused on harm reduction services, following successful models from countries such as Switzerland and the Netherlands.
Aware of the direct linkage between drug consumption and the transmission of infectious diseases, Sananim started implementing HCV activities within their harm reduction services during the drug consumption boom in Czechoslovakia. Thanks to those timely efforts, an epidemic of infectious diseases was avoided.
Sananim now offers a comprehensive programme of services. Their HCV activities are articulated in outreach programmes, mobile units and a drop-in centre. Through them, people who use drugs (PWUD) have access to sterile needle/syringe programmes (NSP), testing, basic medical care, treatment, education and information. Sananim also has a training programme for peers and hires peers as staff members.
Sananim services mostly target PWUD of which one-third are women. The organisation also offers services to other related groups, such as men-who-have-sex-with-men (MSM), sex workers, the Roma population, and other ethnic minorities. In the near Futures, they aim to increase their services to different hidden groups and try to raise awareness of non-substance-related dependence issues such as gambling, gaming and sex.
Awareness & Prevention
Sananim staff start conversations with clients about different HCV prevention practices, emphasising how HCV and infectious diseases can spread through the sharing of contaminated injection equipment. They raise awareness by distributing materials on harm reduction, organising trainings and informative campaigns.
In order to assure good quality services, Sananim employs medical staff who test the competences of newcomers and, later, offer them a detailed course of instruction. Moreover, they arrange special trainings and materials for staff and organise team meetings to discuss new developments and treatments.
Each test is run in accordance with national Czech standards – pre/post-test counselling, testing, linkage to care, education, explanation and clarification of the prevention, treatment and retreatment, reinfection and to reduce and eliminate testing and treatment barriers.
Onsite testing is provided through capillary blood sampling which was chosen due to its low cost. In Czechia, community-based testing is allowed without the involvement of medical staff. External to Sananim, it is possible to have venepuncture, PCR, RNA, HCV core antigen assay and Fibroscan-elastography. In the case whereby a client tests positive, Sananim helps the client to get a confirmatory test with an external medical institution.
Sananim offers regular HCV and HBV testing and HBV vaccination to its staff and it participates in the European HIV/HCV Testing Week.
Treatment & Care
Following a confirmatory test, the client is directed to a consultation with a hepatologist who can prescribe treatment on site or externally. During DAA treatment, the client does not need to abstain from drug and/or alcohol use although disease self-management support is provided by the organisation, such as diet and nutrition. Sananim provides pre- and post-test counseling based on a specific protocol, including a talk with a counselor, nurse or a medical doctor.
Each case is supported, if necessary, through a contract between Sananim, the client and Hepatology Centres that includes treatment cooperation, mandatory visits of the centre and consultation with a hepatologist and drug dispensing.
Additional resources are required to hire, train and support peer staff and to pay for equipment and routine service provision. Attitudinal changes within the medical profession, and changes in national level policies, are required to facilitate harm reduction service implementation.
Sananim would also like to use the new detection systems which enable automatic, fully integrated molecular testing to test difficult-to-reach patients and shorten the time to therapy as much as possible.
Advocacy, Sustainability and Transferability
Sananim is involved in various advocacy campaigns. They have been successful in advocating for the treatment of PWUD through influencing a proposal by health authorities to deny treatment for active drug users. Currently, they are actively working to overcome the stigmatisation of PWUD, specifically PWUD living with hepatitis.
Sananim states that the key to their success lies in their ability to reach hidden communities and to continuously search for new users for their services. They believe that to effectively help a person, an integrated approach to support is required.
c/o De Regenboog Groep
European Harm Reduction
1013 GE Amsterdam
tel. +31 20 570 7829
fax.+31 20 420 3528
Visit our Facebook page.