APDES is a community-based organisation based in Porto, Portugal. The goal of APDES is to promote health and to advocate for the rights of sex workers, people who use drugs (PWUD) and other vulnerable groups, as well as their communities, through projects designed with such groups that guarantee the well-being and health of participants. Specifically, APDES seeks to decrease the risks associated with drug use and sexual activity at the individual and community level through adequate interventions and to research more effective ways to protect such marginalised people.

APDES has sustainable and ongoing hepatitis-related activities through regular funding and has staff, including peer workers, dedicated to the delivery of testing as well as pre- and post-test counselling.

A close partner is CASO, a drug user union. Peer involvement, paid and active since 2009, has played a crucial role in proving the positive effects of treatment and in creating the atmosphere of ’one of us advocating among physicians’.

APDES promotes most of its HCV activities through its mobile unit, GIRUGaia, an outreach team that works with PWUD and has daily contact with them. It includes an open space for welcoming clients and to facilitate the delivery of specific health education about HCV and other infectious diseases. APDES also actively promotes campaigns, such as World Hepatitis Day, to raise awareness among its clients and their partners.

Since December 2016, GIRUGaia has been implementing a project to promote knowledge and sensitise drug users and marginalised populations of the importance of HCV medical treatment whilst also contributing to the epidemiological knowledge on HCV and raising awareness among healthcare professionals. Staff are regularly informed about new developments regarding blood borne infectious diseases through information materials, team meetings, as well as internal and external educational workshops and trainings.

GIRUGaia offers on-site HIV, HCV, HBV and syphilis testing and counseling, including rapid diagnostic tests, dried blood spot, venipuncture, and external HCV core antigen assay as well as fibroscan-elastography. Two GIRUGaia staff, a nurse and a harm reduction worker, conduct the tests.

During pre-test counselling, staff talk about drug use and sexual practices and the specific risk situations that require a test to be undertaken as well as infectious diseases and their early symptoms and the referral process. In the case of a positive result, the staff member informs the client about the referral process and specific treatments. If the test result is negative, the staff member talks with the client about risk practices, safer drug consumption and sexual practices as well as the necessity for regular testing.

Clients of APDES can access HCV treatment on-site and externally. They can also benefit from disease self-management support and liver health monitoring and assessment.

Clients can receive daily treatment in the Combined Therapy Programme on-site, enabling HIV and tuberculosis treatment and psychiatric medicines to be dispensed at the same time at GiruGaia. If a client wishes to be enrolled in opioid substitution therapy (OST), the team can integrate the client at that precise moment with a maximum dose of 30 milligrams and without a medical appointment.

Overall, APDES is equipped to deliver comprehensive hepatitis services but additional resources are necessary to meet the requirements of the existing demand for services. For example, the organisation requires more staff, more educational and training materials and more funds to purchase equipment and to run services as well as a change in national level policies to facilitate the services offered to clients.

A change in the attitude of the medical sector is also sought. As an illustration, GIRUGaia has a small group of clients who do not want to commit to the HCV treatment process because it can start only after a regular medical appointment at the hospital. This situation would change if the hospital facilitated its services on the street, almost like the GIRUGaia mobile unit.

APDES promotes awareness-raising campaigns among its clients, in online social networks, and on the street, advocating for the rights of PWUD and, in particular, on health questions and human rights.

It participates in meetings at the local and national level to influence the political and administrative agenda to promote these rights and access to the most effective treatment. It also attends health congresses, advocating for its target groups, discussing their unique needs and concerns. Since 2015, as a result of joint efforts, HCV treatment has become easier to access by PWUD.

APDES funding is project-based and requires new proposal submissions every 20 to 24 months. Once a project is approved, a new cycle begins.

The success of the APDES programme relies on the excellent and trusting relationship between their staff and clients, together with the joint promotion of therapeutic approaches it has with its partners as well as the financially remunerated peer involvement. Their ability to quickly integrate new clients without the need for medical approval was recognised in 2014 as a good practice by the World Health Organization (WHO) as was the therapeutic combined programme.