BACKGROUND: The harm reduction (HR) approach to injecting drug use was rapidly adopted in Central Europe following the fall of the Iron Curtain. The associated social and economic transformation had significant consequences for drug policies in the region. A large number of emerging services have been dependent on funding from a wide range of national and/or local funding programmes, which continue to be unstable, and closely associated with political decisions and insufficient institution building. A sharp distinction is made between health and social services, often without regard to client input. The main objective of the paper is to identify the causes of the funding problems currently faced by HR services in the context of their history of institution building which represents a major threat to the future of HR services in the region. METHODS: Qualitative content analysis of documents was conducted in the development of two case studies of the Czech and Slovak Republics. The body of documentation under study comprised policy documents, including National Drug Strategies, Action Plans, ministerial documents, and official budgets and financial schedules, as well as documents from the grey literature and expert opinions. RESULTS: The insufficient investments in finalising the process of the institution building of HR services have resulted in a direct threat to their sustainability. An unbalanced inclination to the institutionalisation of HR within the domain of social services has led to a misperception of their integrity, as well as to their funding and long-term sustainability being endangered. In addition, this tendency has had a negative impact on the process of the institutionalisation of HR within the system of healthcare. CONCLUSION: The case study revealed a lack of systemic grounding of HR services as interdisciplinary health-social services. The aftermath of the financial crisis in 2008 fully revealed the limitations of the funding system established ad hoc in the 1990s, which remains present until today, together with all its weak points. The entire situation is responsible for the dangerous erosion of the interpretation of the concept of harm reduction, which is supported by various stereotypes and false, or ideological, interpretations of the concept.

• Klíčová slova
• Case studies, Comparative qualitative analysis, Czech Republic, Drug policy, Financial support, Harm reduction, Slovak Republic, System analysis,
• MeSH
• lidé MeSH
• poruchy spojené s užíváním psychoaktivních látek * MeSH
• poskytování zdravotní péče MeSH
• snížení rizika poškození * MeSH
• veřejná politika MeSH
• zdravotnické služby MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND AND AIMS: Despite advances in our knowledge of effective services for people who use drugs over the last decades globally, coverage remains poor in most countries, while quality is often unknown. This paper aims to discuss the historical development of successful epidemiological indicators and to present a framework for extending them with additional indicators of coverage and quality of harm reduction services, for monitoring and evaluation at international, national or subnational levels. The ultimate aim is to improve these services in order to reduce health and social problems among people who use drugs, such as human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection, crime and legal problems, overdose (death) and other morbidity and mortality. METHODS AND RESULTS: The framework was developed collaboratively using consensus methods involving nominal group meetings, review of existing quality standards, repeated email commenting rounds and qualitative analysis of opinions/experiences from a broad range of professionals/experts, including members of civil society and organisations representing people who use drugs. Twelve priority candidate indicators are proposed for opioid agonist therapy (OAT), needle and syringe programmes (NSP) and generic cross-cutting aspects of harm reduction (and potentially other drug) services. Under the specific OAT indicators, priority indicators included 'coverage', 'waiting list time', 'dosage' and 'availability in prisons'. For the specific NSP indicators, the priority indicators included 'coverage', 'number of needles/syringes distributed/collected', 'provision of other drug use paraphernalia' and 'availability in prisons'. Among the generic or cross-cutting indicators the priority indicators were 'infectious diseases counselling and care', 'take away naloxone', 'information on safe use/sex' and 'condoms'. We discuss conditions for the successful development of the suggested indicators and constraints (e.g. funding, ideology). We propose conducting a pilot study to test the feasibility and applicability of the proposed indicators before their scaling up and routine implementation, to evaluate their effectiveness in comparing service coverage and quality across countries. CONCLUSIONS: The establishment of an improved set of validated and internationally agreed upon best practice indicators for monitoring harm reduction service will provide a structural basis for public health and epidemiological studies and support evidence and human rights-based health policies, services and interventions.

• Klíčová slova
• Best practice, Coverage, Drug services, Epidemiology, Evidence-based, HCV, HIV, Harm reduction, Indicators, Injecting drug users/IDU, Interventions, Knowledge exchange, Monitoring, People who inject drugs/PWID, People who use drugs/PWUD, Substance abuse,
• MeSH
• konsensus MeSH
• kvalita zdravotní péče * MeSH
• lidé MeSH
• poruchy spojené s užíváním psychoaktivních látek terapie   MeSH
• snížení rizika poškození * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• konsensus - konference MeSH
• práce podpořená grantem MeSH
• Research Support, N.I.H., Extramural 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

BACKGROUND: In order to reduce injecting drug use, low-threshold facilities in the Czech Republic have started to distribute empty gelatine capsules as an oral alternative of drug application for those injecting methamphetamine. This report reviews implementation of this intervention and its possible benefits and limitations. METHODS: Between December 2008 and January 2009, 109 low-threshold facilities were asked to complete a questionnaire about the capsule programmes. Two focus groups were conducted, one with professionals involved in distribution and one with peer outreach workers who were interviewed on their experience of using the capsules. RESULTS: A total of 50 facilities (46%) responded to the questionnaire; 16 (32%) distributed the capsules regularly and 19 (38%) were planning to introduce this practice. The main target groups were injecting users of methamphetamine whose veins had been damaged, and methamphetamine users wishing to reduce injecting. The advantages of capsules, as perceived by service staff and peer outreach workers, were their easy use and the satisfactory effect of the oral application; health risks related to the oral use of methamphetamine were considered drawbacks. CONCLUSION: Capsule distribution is a promising harm reduction approach for injectors of methamphetamine or other stimulants; nonetheless its benefits and limitations should be further analysed in an in-depth longitudinal study.

• MeSH
• aplikace orální MeSH
• farmaceutická chemie MeSH
• hodnocení programu MeSH
• injekce intravenózní MeSH
• intravenózní abúzus drog prevence a kontrola   MeSH
• lidé MeSH
• methamfetamin aplikace a dávkování   škodlivé účinky   chemie   MeSH
• pomocné látky chemie   MeSH
• poruchy spojené s užíváním amfetaminu rehabilitace   MeSH
• příprava léků MeSH
• průzkumy a dotazníky MeSH
• snížení rizika poškození * MeSH
• stimulanty centrálního nervového systému aplikace a dávkování   škodlivé účinky   chemie   MeSH
• tobolky MeSH
• želatina chemie   MeSH
• zjišťování skupinových postojů MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH
• Názvy látek
• methamfetamin MeSH
• pomocné látky MeSH
• stimulanty centrálního nervového systému MeSH
• tobolky MeSH
• želatina MeSH

OBJECTIVES: Emerging evidence suggests that the use of safer nicotine products (SNPs), such as e-cigarettes and heated tobacco products (HTPs) poses significantly lower health risks than continued smoking, particularly over the short and medium term. However, it remains uncertain whether the public has been adequately informed about these relative risks. This study assesses the perceived relative harm of e-cigarettes compared to conventional cigarettes in Ukraine. METHODS: Two nationally representative surveys were conducted in February 2021 and December 2022. Participants, irrespective of their smoking status, were asked whether they agreed with the statement that "using e-cigarettes is more harmful than smoking conventional cigarettes". The surveys also included questions about tobacco product usage, the most dangerous substances in cigarettes, and smoking cessation methods. The data were statistically analysed by deriving design-based weighted point estimates and 95% confidence intervals for the proportions within each response category. RESULTS: In 2022, 38.1% (95% CI: 35.3-40.9) of adults believed that e-cigarettes were more harmful than cigarettes and the perception of relative harm remained relatively unchanged between the two surveys. Furthermore, 56.2% (95% CI: 50.0-62.2) of current cigarette smokers agreed with this statement, while only a small percentage of vapers (e-cigarette users) 7.4% (95% CI: 1.5-30.0) perceived e-cigarettes as more harmful than conventional cigarettes. Among non-smokers and dual users the share was 33.4% (95% CI: 30.0-36.9) and 32.7% (95% CI: 25.1-41.5), respectively. CONCLUSION: Our findings indicate that in Ukraine the perception that e-cigarettes are more harmful than cigarettes, or the lack of knowledge regarding relative risks, prevails. This highlights the importance of accurate risk communication to promote a harm reduction approach to tobacco use.

• Klíčová slova
• SNPs, e-cigarettes, perceived harm, smoking, tobacco harm reduction,
• MeSH
• dospělí MeSH
• kouření epidemiologie   MeSH
• kuřáci MeSH
• lidé MeSH
• odvykání kouření * MeSH
• systémy dodávající nikotin elektronicky * MeSH
• tabákové výrobky * MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

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: Condom provision is one of the most effective harm reduction interventions to control sexually transmitted infections (STIs) including HIV/AIDS and viral hepatitis in prisons. Yet, very few countries around the world provide prisoners with condoms. The present study aimed to elucidate principles of effective prison-based condom programs from the perspective of European public health and prison health experts. METHODS: As a part of the "Joint Action on HIV and Co-infection Prevention and Harm Reduction (HA-REACT)" twenty-one experts from the field of prison health from eight European countries were invited to discuss the principles of condom provision programs in prisons within two focus groups. The audio records were transcribed verbatim, coded, categorized, and analyzed using thematic analysis method. RESULTS: Six components emerged from the analysis as essential for successful condom programs in prisons: (1) highlighting the necessity of condom provision in prisons, (2) engagement of internal and external beneficiaries in all stages of designing and implementing the program, (3) conducting a pilot phase, (4) condom program in a comprehensive package of harm reduction interventions, (5) vending machine as the best method of condom distribution in prisons and (6) assuring the sustainability and quality of the intervention. CONCLUSION: Results of the present study can help prison health policy makers to design and conduct acceptable, accessible and high-quality prison-based condom provision programs, and consequently to mitigate the burden of STIs in prisons. Having access to high-quality healthcare services including condom provision programs is not only the right of prisoners to health, but also is a move towards achieving the sustainable development goal 3 of "leaving no one behind."

• Klíčová slova
• Condom, HIV, Prison, Sexually transmitted infections, Viral hepatitis,
• MeSH
• kondomy MeSH
• lidé MeSH
• sexuálně přenosné nemoci * prevence a kontrola   MeSH
• snížení rizika poškození MeSH
• vězni * MeSH
• věznice MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: Drug consumption rooms (DCRs) are harm reduction facilities providing safer and hygienic setting for supervised administration of drugs aimed at decreasing negative health and social consequences of drug use. The first DCR in Czechia was opened in September 2023 in city of Brno in a mobile form operating in a socially excluded area (SEA). A research project informed the implementation of the DCR. METHODS: A mixed methods design was applied in the following phases: desk review, research before and after the launch of the mobile DCR, and routine monitoring of programme performance. Two cross-sectional questionnaire surveys among PWUDs (n = 131 and 135), ethnographic observation, focus group (n = 19), interviews with PWUDs (n = 26 and 19), with personnel of addiction services and local officials (n = 16 and 12), and residents (n = 7 and 6) were performed prior to and after the launch of the DCR. Thematic analysis of qualitative data, descriptive and regression analyses of quantitative data were performed. RESULTS: There was a need and high willingness to use the DCR among potential clients. The significant predictors were opioid use (adjusted odds ratio, AOR = 3.4 in survey 1 and 3.9 in survey 2), drug injection in the last 30 days (AOR 4.3 in survey 1), being in the probationary period during the previous 30 days (AOR 10.0 in survey 1), witnessing an overdose in the past 30 days (AOR 8.5 in survey 2), HCV positivity ever in life (AOR 2.9 in survey 2), living in SEA (AOR 2.7 in survey 2) and Roma ethnicity (AOR 2.8 in survey 2). The beginnings of the DCR were relatively slow with low initial number of clients and drug administrations. However, with time, and programme adjustments following research results, the attendance at the facility has grown. CONCLUSIONS: Research was instrumental in shaping the DCR in Brno before and during its implementation. The DCR showed a potential to attract the most vulnerable PWUDs from SEA. Despite a slow start, the DCR has become an integral part of low-threshold services for PWUDs in Brno and has proven its feasibility in the Czech settings.

• Klíčová slova
• Drug consumption room, Formative research, Harm reduction, High-risk drug use, Injecting, Safer administration,
• MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mobilní zdravotnické jednotky * organizace a řízení   MeSH
• poruchy spojené s užíváním psychoaktivních látek * MeSH
• průřezové studie MeSH
• průzkumy a dotazníky MeSH
• snížení rizika poškození * MeSH
• uživatelé drog * statistika a číselné údaje   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

BACKGROUND: Personal cancer risk assessments enable stratified care, for example, offering preventive surgical measures such as risk-reducing mastectomy (RRM) to women at high risk for breast cancer. In scenario-based experiments, we investigated whether different benefit-harm ratios of RRM influence women's consideration of this, whether this consideration is influenced by women's perception of and desire to know their personal cancer risk, or by their intention to take a novel cancer risk-predictive test, and whether consideration varies across different countries. METHOD: In January 2017, 1,675 women 40 to 75 years of age from five European countries-Czech Republic, Germany, UK, Italy, and Sweden-took part in an online scenario-based experiment. Six different scenarios of hypothetical benefit-harm ratios of RRM were presented in accessible fact box formats: Baseline risk/risk reduction pairings were 20/16, 20/4, 10/8, 10/2, 5/4, and 5/1 out of 1,000 women dying from breast cancer. RESULTS: Varying the baseline risk of dying from breast cancer and the extent of risk reduction influenced the decision to consider RRM for 23% of women. Decisions varied by country, risk perception, and the intention to take a cancer risk-predictive test. Women who expressed a stronger intention to take such a test were more likely to consider having RRM. The desire to know one's risk of developing any female cancer in general moderated women's decisions, whereas the specific desire to know the risk of breast cancer did not. CONCLUSIONS: In this hypothetical scenario-based study, only for a minority of women did the change in benefit-harm ratio inform their consideration of RRM. Because this consideration is influenced by risk perception and the intention to learn one's cancer risks via a cancer risk-predictive test, careful disclosure of different potential preventive measures and their benefit-harm ratios is necessary before testing for individual risk. Furthermore, information on risk testing should acknowledge country-specific sensitivities for benefit-harm ratios.

• MeSH
• chování snižující riziko MeSH
• dospělí MeSH
• genetická predispozice k nemoci * MeSH
• lidé středního věku MeSH
• lidé MeSH
• mastektomie psychologie   MeSH
• nádory prsu genetika   patologie   psychologie   chirurgie   MeSH
• prognóza MeSH
• průzkumy a dotazníky MeSH
• riziko MeSH
• rozhodování * MeSH
• senioři MeSH
• úmysl * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH
• Itálie MeSH
• Německo MeSH
• Spojené království MeSH
• Švédsko MeSH

• Klíčová slova
• RADIATION PROTECTION *, RADIOMETRY *,
• MeSH
• lidé MeSH
• radiační ochrana * MeSH
• radiometrie * MeSH
• snížení rizika poškození * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH