Good Practice Collection
Spain – Creu Roja Barcelona
- CAS/ARD Lluis Companys Red Cross Barcelona is a harm reduction service provider based in Barcelona, Spain.
- Team composition: social workers; nurses; medical doctor; psychologists; social educators; psychiatrist, lawyer, administrative worker and a director. It has the support of two Hospital Clinic of Barcelona workers: an hepatits reference nurse and a hepatologist.
- Services provided: low-threshold drug service and counselling; distribution of needles and syringes, paraphernalia, condoms; opioid substitution therapy; drug consumption room; drop-in centre; laundry room, nursery and space of a food supplement.
- Target groups: people who use injected drugs (sex workers; men-who-have-sex-with-men (MSM); people experiencing homelessness). Total of 378 clients last year and 23,533 visits annually.
- Keywords: HCV care on site; drug consumption room; hepatitis ambassador; pilot project
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The CAS/ARD Lluis Companys of Red Cross Barcelona Hepatitis C programme, is part of a more extensive plan for people who use drugs (PWUD) in Barcelona: DEFINING THE BEST ESTRATEGY FOR GLOBAL HCV SCREENING, LINK-AGE TO CARE, EDUCATION AND PREVENTION IN PWID POPULATION (GILEAD SCIENCES: CHIME). The primary stakeholders within the programme are the Government of Catalonia, Subdirecció General de Drogodependències de la Generalitat de Catalunya, an important local hospital, Hospital Clínic de Barcelona, and the Red Cross. As PWUD have not been attending other social security services, the Hospital Clinic and the administration of Catalunya, formed a pilot department to help those people in need. The department provides drug substitution treatment with methadone and Red Cross Barcelona has a medical centre open to everyone and also, has harm reduction services available for PWUD or those experiencing homelessness. The organization has sustainable and ongoing hepatitis-related activities with regular funding. It has dedicated staff for testing as well as pre- and post-test counselling.
Awareness & Prevention
The main difference between the Red Cross programme and others is that their clients can get complete HCV care on-site and the site is visited by a nurse once a week and a hepatologist once a month to offer consultations. All Red Cross clients and staff have access to information and education about HCV through handout materials, educational workshops, and face-to-face meetings including with an ‘hepatitis ambassador’. Staff try to carefully prevent infection and more, specifically, co-infection between their clients and the drug using community. Before treatment, every client follows an individual HCV information session with the nurse in addition to the Red Cross 2 programme which assists PWUD living with HIV.
Even though the programme and treatment have no specific criteria and are open to everyone, the efforts of Red Cross Barcelona are mostly dedicated towards PWUD. Clients must have public health insurance to benefit from treatment. In case they do not have insurance, they can get coverage on-site through a short-cut route.
The programme is closely monitoring clients by registering them in a database. The registries are shared with different stakeholders and for various purposes. Firstly, because the programme is a pilot at present, the data is used for pilot purposes. Secondly, if a client is arrested or is put in jail, a special note in the database enables follow-up for uninterrupted treatment. Finally, the data is also used for research purposes to help other organisations and researchers to learn about the impact of the programme. While the programme is still very new, it is generating essential results.
Red Cross Barcelona offers regular testing for staff and clients on-site. Every client has the opportunity to take a venipuncture test and HCV core antigen assay. If a person is tests positive, a staff member makes an appointment with a nurse from the hospital in Barcelona for a confirmatory test and also for further assistance in accessing treatment.
Clients can benefit from a pre- and post-test counselling with a counselor, nurse or a medical doctor.
Treatment & Care
When clients receive confirmation, they sign a treatment agreement and, later, do a fibroscan to assess their condition. Medical staff try to test the client not only HCV but also HIV and Cirrhosis, amongst other conditions. After diagnosis and the prescribing of treatment, a staff member offers the client a pill box with the required pills to be taken regularly. The doctor can decide between one of the two durations of treatment, which are twelve weeks or eight weeks. Within the following 12 weeks of treatment, the client takes another test to confirm that the infection has gone. During treatment, there is no need to be abstinent from drug consumption, including alcohol, which allows Red Cross to attract clients into treatment. However, if treatment is sought by an individual without going through Red Cross, the individual must fulfill the one primary criteria, which is to stop using drugs and alcohol. Therefore, in such cases, people are usually not accepted for treatment.
This programme is connected with another centre in surroundings of Barcelona involved in the Hepatitis C pilot programme. Red Cross shares client information with this centre so as to be able to offer regular harm reduction services. The focus only on PWUD registered with them as, unfortunately, they do not yet have sufficient capacity to take on the clients of other centres. The centre also has a lawyer who visits twice each week to offer consultations on legislative matters, advice, and to provide assistance.
Red Cross Barcelona’s team thinks that they do not need to implement additional services because their services are complex and sufficient. The main challenge is to finalise the pilot version of the programme and make it accessible for everyone. They feel confident in the programme’s success as it is already expanding to one more centre. Although this center is equipped to deliver comprehensive hepatitis services, with more funding the programme might further expand and offer services to more and more clients.
Overall, there is a need in the national treatment guidelines to encourage HCV community testing and HCV treatment for PWUD. The attitude of the medical sector has also to change with regards to providing services for drug users and in regard to the harm reduction approach and services.
Advocacy, Sustainability and Transferability
Red Cross does not have any advocacy activities itself as it is just a pilot programme; but it is very much involved in the local administrative developments on behalf of the current programme which is regarded as successful. Overall, the organisation does not advocate solely for PWUD and harm reduction since its focus is much wider: encompasses any person in a vulnerable situation.
It has consistent, strong political support which enables the existence of its programme and provides excellent administrative support. The Government of Catalunya has a specific department which generates findings and keeps the government informed about the benefits of harm reduction services.
The strongest point of this programme is its complete focus on PWUD. Everybody treats clients with a very human attitude, allows them to speak up and have a say, and makes them feel that they are heard by staff.
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