Towards micro-elimination of hepatitis C in Skåne Region – The needle exchange programs as key assets.

Author: Marianne Alanko Blomé, Madlene Holmqvist, Farnaz Jalalvand, Mathilda Eliasson

Theme: Models of Care Year: 2023

Skåne Region, in southernmost Sweden, is a forerunner for providing access to care for people who inject drugs. For two decades, 1986-2006, only two needle exchange programs (NEPs) were permitted in Sweden, both in Skåne. Still today NEP access is highest here, as is access to opioid agonist therapy (OAT). Skåne has approximately 1,4 million inhabitants and the number of people who inject drugs has previously been estimated to around 1200.

Description of model of care/intervention:
The four NEPs (Malmö, Lund, Kristianstad and Helsingborg) belong to ID clinics and provide testing, assessment and treatment for hepatitis C (HCV) on site. All NEP participants are tested for HIV, hepatitis B (HBV) and HCV upon enrollment and then 3-monthly for relevant virological markers. HCV RNA positive participants are offered assessment with transient elastography. HCV treatment is prescribed and administered on site according to the participant’s individual needs.

HCV treatment uptake has steadily increased during the past years. In 2022, 882 NEP participants in total were tested for HCV at the four NEPs; 179 (20%) were anti-HCV negative. Of those anti-HCV positive only 113 (16%) were still HCV RNA positive in their last sample in 2022, and at least 20% of them had started HCV treatment by the end of the year.

Conclusion and next steps:
Four well-functioning NEPs strategically located at ID clinics in Skåne Region provide efficient access to HCV treatment. Collaboration between ID clinics and addiction care enables HCV treatment at the >25 OAT clinics in the region. These units also form a network for provision of Take Home Naloxone. Next steps towards HCV elimination include providing testing and linkage to care at the five prisons and other correctional health services. Thus, the collective levels of HCV viremia are expected to decline further, decreasing the risk of reinfection.

Disclosure of Interest Statement: 
The authors have nothing to disclose in relation to this abstract.

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