9 January 2023
CATIE — Canada’s Source for HIV and Hepatitis C Information — attended the INHSU 2022 conference and has created a detailed summary and video series of the key themes and takeaways, highlighting the opportunities and challenges for Canadians in the connected fields of health and hepatitis C elimination among people who use drugs.
Canadian research and voices were prominent at INHSU 2022, including discussions on reducing harms and improving health, most notably regarding safe supply. However, they were nearly absent in discussions about tracking progress towards hepatitis C elimination at the pan-Canadian or regional level.
Some of the key takeaways include:
Examples of successful hepatitis C elimination programs
Many presenters shared success stories for smaller-scale hepatitis C elimination projects. These projects often focused on ways to simplify the patient journey, reduce the number of steps required across the cascade of care and improve access to services. Presenters challenged the idea of people being “hard to reach” and emphasized that it is really services and care providers who can be hard to access (Andrea Sereda, Ontario; Mary Munro, UK). Common features of services included:
- treating people where they are by co-locating hepatitis C testing and treatment services within harm reduction or addiction services
- treating people where they are through mobile services, outreach or prison in-reach
- peer-led and peer-supported models of care
- nurse-led models of care
- offering services that address needs beyond hepatitis C, such as wound care and other primary care, as well as access to housing, income supports, substance use disorder treatment, etc.
Point-of-care testing and dried-blood-spot testing were both highlighted as part of low-barrier and simplified hepatitis C services. One novel testing approach in Australia involved using self-collection of dried-blood-spot tests. Participants registered themselves online to receive a test kit in the mail and then mailed the dried-blood-spot test card back to the lab for analysis (Anna Conway, Australia). Another novel testing approach involved integrating hepatitis C antibody self-testing with HIV self-testing platforms through a trial in Georgia and Malaysia (Sonjelle Shilton, Switzerland).
What are the key learnings you will take home from INHSU 2022?
Canada as a global leader in safe supply programs
Decriminalization on its own is not enough. There also needs to be access to a safe supply of drugs. Forms of safe supply programs have existed for decades in some countries. It can be administered through different types of models including heroin-assisted treatment, medical safe supply and compassion clubs (Matthew Bonn, Nova Scotia). Safe supply is not addiction treatment, it is a harm reduction intervention (Alexandra Holtom, Quebec; Andrea Sereda, Ontario; Emmet O’Reilly, Ontario), and its goal is to convert people using drugs from the unregulated supply to using drugs of known dose and purity (Andrea Sereda, Ontario).
Promising results were shared from a number of Canadian medical safe supply initiatives, including in British Columbia, Nova Scotia, Ontario and Quebec. In one evaluation of a program out of the London InterCommunity Health Centre, positive outcomes included improvements in physical and mental health, as well as reductions in overdoses, emergency room use, hospital admissions, illicit fentanyl use, engagement in survival crime and, in some instances, even led to the cessation of injection drug use (Andrea Sereda, Ontario). As emphasized by Alexandra Holtom (Quebec), safe supply is not just about saving lives, but also about enabling life.
What are emerging topics related to hepatitis C and the health of people who use drugs?
Improving access to harm reduction services for people who use drugs
Presentations from around the world featured a wide range of harm reduction topics including:
- efforts to improve access to take-home naloxone (Danilo Falzon, UK; Mary Munro, UK)
- drug checking as a harm reduction intervention (Danilo Falzon, UK; Emmet O’Reilly, Ontario)
- the importance and benefits of supervised consumption sites/drug consumption rooms (Ann Livingston, British Columbia) and needle and syringe programs (Andrew McAuley, UK; Louisa Degenhardt, Australia)
- much-needed improvements in hospital-based care for people who use drugs including access to harm reduction interventions in hospitals (Magdalena Harris, UK)
- supporting the agency of people taking OAT including choice of medication and choice of when, how and why they take medication (Sione Crawford and Jane Dicka, Australia; Louise Vincent & Nick Voyles, USA with the Methadone Manifesto)
- the essential role of gender-responsive services to meet the needs of people who use drugs, including the need for harm reduction services designed for women and non-binary people (Alison Marshall, Australia; Aura Roig Forteza, Spain; Rose Schmidt, Ontario)
- the critical need to address wider socioeconomic inequalities including access to adequate income, housing, mental health services and more to improve the lives of people who use drugs (Andrew McAuley, UK)
When it comes to creating change, presenters shared examples of when grassroots, community-led action has worked better than waiting for policy-makers to enact change. People who use drugs have operated underground needle exchanges at times when they were illegal or inadequately meeting people’s needs and opened unsanctioned supervised consumption sites or overdose prevention sites when the politics of the day failed to do so. The Drug User Liberation Front started their compassion club at a time in Canada when there is limited local access to medicalized safe supply (Ann Livingston, British Columbia; Magdalena Harris, UK). Shaun Shelly (South Africa) also emphasized the power of working at the municipal level to create change and shared a success story that resulted in a trial for a number of new policies in his local community, which he referred to as a “policy sandbox”. Through finding common ground, connecting on shared goals, building relationships and humanizing one another, he fostered collaboration among the local police, municipality, community policing forums and people who use drugs.
Rivka Kushner (left) is the manager of national hepatitis C knowledge exchange at CATIE.
Brooke Nolan (right) is marketing and communication manager at INHSU.