Good practice examples
SWITZERLAND – Arud, Centre for Addiction Medicine
short-cut-route-for-insurance; paid-peer-workers-peer2-peer-education; advocacy-for-decriminalization-of-drug-use;
TEST; LINK; TREAT-ext; LTA; PWUD; NURSE; MULTI;
Where – Services provided:
psychotherapy; mental healthcare; primary care; HIV and HCV care; opioid substitution therapy (OST); low-threshold drug services; counseling; distribution of needles and syringes, drug use paraphernalia and condoms.
Who – Target groups:
people who use drugs (PWUD) or inject drugs (PWID); HIV-positive men-who-have-sex-with-men (MSM).
How – Team composition:
psychiatrists; psychotherapists; medical doctors; infectious disease specialist; nurses; social workers; peer workers (paid).
Arud was founded in Zurich, Switzerland, in 1991 by a group of people interested in harm reduction services. The association was in response to the continuously open drug scene in the city where people who used drugs (PWUD) had no access to sterile needles and syringes and there was no opioid substitution therapy (OST) available.
Arud was a pioneering organisation when it started with its low-threshold methadone programme in 1992. In the following years, OST was extended to include diacetylmorphine and further substitutes. The provision of sterile needles and syringes as well as basic medical care for PWUD has been part of their service from the outset. HIV and HCV care services were naturally included as a large part of Arud’s patients were affected by these diseases. Today, Arud treats every kind of dependency disorder and is the leading out-patient clinic for dependence medicine in Switzerland.
Together with a partner organization, they also provide health services with a special focus on STIs for men-who-have-sex-with-men (MSM). Arud researches the outcomes of their services through scientific studies.
Awareness & Prevention
To raise awareness of HCV among patients, Arud generates print and video materials with informative, face-to-face discussions conducted by their (paid) peer team. The Arud team, including specially trained hepatitis nurses, has hepatitis trainings at least once per year to provide patients with basic, up-to-date information. Arud also applies a specific ‘hygiene protocol’ for staff and clients.
ARUD organises, and participates in, the promotion of awareness and testing campaigns together with their partners such as ‘Swiss Hepatitis’ and ‘INHSU’; it also participates in World Hepatitis Day and is member of the World Hepatitis Alliance.
On-site, Arud uses a normal blood test, which is sent to a laboratory (e.g. HCV RNA) and runs its own pharmacy to provide the necessary medicines based on patient prescriptions. Patients can also benefit from testing methods such as venipuncture by highly experienced staff. Arud also provides patients with pre- and post-counselling, including talks with a nurse, medical doctor or a peer worker.
The Arud peer workers offer free, anonymous and rapid testing on-site and while on outreach and team members also visit partner organisations such as drug consumption rooms (DCR’s) to conduct rapid HCV testing and elastography examination.
Every patient at Arud has a personal file, similar to a hospital or a GP facility, and once agreed individually, their data can be used for research purposes.
Treatment & Care
During treatment, every patient is supported by a staff member. However, the less aware a patient is of hepatitis, the harder it is to reach them with the proper treatment. Peer-to-peer education is in place to address this challenge. Under Arud’s package of services, clients can get treatment on-site. It also offers disease self-management support and liver health monitoring and assessment.
Arud has beneficial cooperative agreements with several stakeholders in their region. They work with opioid substitution patients with a special focus on viral hepatitis C while including all their patients in the National Swiss Hepatitis Cohort. They are also members of the Swiss Hepatitis C strategy network which comprises all stakeholders responsible for hepatitis services.
A key challenge for Arud is identifying and understanding the difficulties faced by migrants. Arud would like to improve its ability to make contact with this target group and be able to include them in the programme and offer them services.
Another challenge is the implementation of on-site HCV RNA testing due to the high level of regulations by Swiss authorities for PCR testing outside of accredited labs.
Advocacy, Sustainability and Transferability
Arud is targeting its advocacy at the political level to decriminalise drug use and reduce repression in this field. Arud’s main political demand is market regulation for all psychoactive substances. The criminalisation of drug use is also one of the biggest barriers to HCV care. In addition, Arud supports the activities of Swiss Hepatitis to integrate viral hepatitis into the national HIV/STI programme. They have close contact with national health authorities, local politicians and stakeholders while also working with local media outlets to raise awareness and to support advocacy activities.
Arud is mainly financed through the health insurance of its patients. Health insurance is mandatory in Switzerland and paid by social welfare for those who cannot afford it.
Arud believes in the importance and effectiveness of offering services to PWUD under one roof in order to provide an holistic, low-threshold and patient-centred service where patients are treated as equals without prejudice.
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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