BACKGROUND: Harm reduction services, despite their proved effectiveness in the prevention of infectious diseases, are still underdeveloped in several European states. The situation in the Visegrad Group countries is especially interesting. Notwithstanding the shared history, culture and political situation in the last decades, there are significant differences in the state of harm reduction between the countries. METHODS: The research applies the ecological systems model to identify the structural barriers and facilitators affecting organisations providing needle exchange services. It uses a comparative multiple case study design with embedded units of analysis complemented by within-case analysis to establish the relationship between the number and scope of identified factors and the performance of needle exchange services. The qualitative data were collected through semi-structured interviews with professionals working in needle exchange services in the Czech Republic, Poland, Slovakia and Hungary. Additionally, relevant documents, reports and online sources were analysed. RESULTS: A total of 24 themes (structural factors) were identified across 11 categories on 3 levels (mesosystem, exosystem, macrosystem). The list includes themes related to the broader society, politics and policy on state and local level, frameworks and amounts of funding, the situation on the education labour market, and attitudes of local communities, among others. The data shows that in the Czech Republic, many facilitators can be identified. In the three remaining countries, on the contrary, one can observe mostly barriers in NSP services delivery. CONCLUSIONS: The study addresses a highly unexplored topic of the functioning of harm reduction organisations in East-Central Europe. It sheds light on the environment of analysed services, identifying a number of structural factors in effective service delivery in the Czech Republic, Poland, Slovakia and Hungary. The research confirms the significant role of the barriers and facilitators in the services' performance. It highlights the relationships between various elements of the needle exchange programmes' environment, suggesting holistic strategies for addressing them. It also provides a potential starting point for further research.

• Klíčová slova
• Barriers, Challenges, Drug policy, East-Central Europe (ECE), Harm reduction, Needle exchange, Service delivery,
• MeSH
• intravenózní abúzus drog rehabilitace   MeSH
• kulturní charakteristiky MeSH
• lidé MeSH
• poskytování zdravotní péče organizace a řízení   MeSH
• programy výměny jehel a stříkaček organizace a řízení   zásobování a distribuce   MeSH
• snížení rizika poškození MeSH
• zdravotní politika MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH
• Geografické názvy
• Česká republika MeSH
• Maďarsko MeSH
• Polsko MeSH
• Slovenská republika MeSH

BACKGROUND & AIMS: Prevention of hepatitis C virus (HCV) transmission among people who inject drugs (PWID) is critical for eliminating HCV in Europe. We estimated the impact of current and scaled-up HCV treatment with and without scaling up opioid substitution therapy (OST) and needle and syringe programmes (NSPs) across Europe over the next 10 years. METHODS: We collected data on PWID HCV treatment rates, PWID prevalence, HCV prevalence, OST, and NSP coverage from 11 European settings. We parameterised an HCV transmission model to setting-specific data that project chronic HCV prevalence and incidence among PWID. RESULTS: At baseline, chronic HCV prevalence varied from <25% (Slovenia/Czech Republic) to >55% (Finland/Sweden), and <2% (Amsterdam/Hamburg/Norway/Denmark/Sweden) to 5% (Slovenia/Czech Republic) of chronically infected PWID were treated annually. The current treatment rates using new direct-acting antivirals (DAAs) may achieve observable reductions in chronic prevalence (38-63%) in 10 years in Czech Republic, Slovenia, and Amsterdam. Doubling the HCV treatment rates will reduce prevalence in other sites (12-24%; Belgium/Denmark/Hamburg/Norway/Scotland), but is unlikely to reduce prevalence in Sweden and Finland. Scaling-up OST and NSP to 80% coverage with current treatment rates using DAAs could achieve observable reductions in HCV prevalence (18-79%) in all sites. Using DAAs, Slovenia and Amsterdam are projected to reduce incidence to 2 per 100 person years or less in 10 years. Moderate to substantial increases in the current treatment rates are required to achieve the same impact elsewhere, from 1.4 to 3 times (Czech Republic and France), 5-17 times (France, Scotland, Hamburg, Norway, Denmark, Belgium, and Sweden), to 200 times (Finland). Scaling-up OST and NSP coverage to 80% in all sites reduces treatment scale-up needed by 20-80%. CONCLUSIONS: The scale-up of HCV treatment and other interventions is needed in most settings to minimise HCV transmission among PWID in Europe. LAY SUMMARY: Measuring the amount of HCV in the population of PWID is uncertain. To reduce HCV infection to minimal levels in Europe will require scale-up of both HCV treatment and other interventions that reduce injecting risk (especially OST and provision of sterile injecting equipment).

• Klíčová slova
• Direct-acting antivirals, Hepatitis C, Opioid substitution therapy, PWID,
• MeSH
• antivirové látky terapeutické užití   MeSH
• chronická hepatitida C * farmakoterapie   epidemiologie   prevence a kontrola   MeSH
• incidence MeSH
• intravenózní abúzus drog * komplikace   epidemiologie   prevence a kontrola   MeSH
• lidé MeSH
• odhad potřeb MeSH
• opiátová substituční terapie metody   MeSH
• přenos infekční nemoci prevence a kontrola   statistika a číselné údaje   MeSH
• prevalence MeSH
• programy výměny jehel a stříkaček metody   organizace a řízení   MeSH
• teoretické modely MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Research Support, N.I.H., Extramural MeSH
• Geografické názvy
• Evropa epidemiologie   MeSH
• Názvy látek
• antivirové látky MeSH

• MeSH
• hepatitida B epidemiologie   prevence a kontrola   přenos   MeSH
• hepatitida C epidemiologie   prevence a kontrola   přenos   MeSH
• HIV infekce prevence a kontrola   přenos   MeSH
• intravenózní abúzus drog epidemiologie   MeSH
• lidé MeSH
• programy výměny jehel a stříkaček organizace a řízení   MeSH
• Světová zdravotnická organizace * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• zprávy MeSH

BACKGROUND: In eastern Europe, the high prevalence rates of HIV and the hepatitis C virus (HCV) are concentrated among injecting drug users (IDUs). Harm reduction programmes such as needle and syringe programmes and opioid substitution therapy (OST) have been shown to be effective in preventing these infections. However, structural barriers can limit their effectiveness by hindering access. METHODS: Through use of a semi-structured online survey sent to 65 professionals in the region, this study explores the prevalences of age restrictions, user fees or a lack of confidentiality for these programmes as well as HIV/HCV testing programmes. RESULTS: Twenty respondents reported that age restrictions were not widespread in the 11 reporting countries, apart from for OST. User fees were found to be very common in HCV testing and varied for other services. It was stated to be common to inform parents of young IDUs who receive HIV services, but not to inform public authorities when IDUs enter harm reduction programmes. CONCLUSION: Where access to services is limited or confidentiality is compromised, as reported in this pilot study, it is crucial that health-care guidelines and national legislation are reformed to ensure access to these evidence-based interventions.

• MeSH
• dostupnost zdravotnických služeb organizace a řízení   MeSH
• důvěrnost informací MeSH
• hepatitida C diagnóza   epidemiologie   prevence a kontrola   MeSH
• HIV infekce diagnóza   epidemiologie   prevence a kontrola   MeSH
• intravenózní abúzus drog prevence a kontrola   terapie   MeSH
• lidé MeSH
• methadon terapeutické užití   MeSH
• pilotní projekty MeSH
• poplatky a výdaje MeSH
• prevalence MeSH
• programy výměny jehel a stříkaček organizace a řízení   MeSH
• snížení rizika poškození * MeSH
• věkové faktory MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• východní Evropa epidemiologie   MeSH
• Názvy látek
• methadon MeSH