Luxembourg’s hepatitis C screening and care in drug users selected as example of best practice in Europe

2019 - 07 - 25

The World Hepatitis Day on 28th July is an opportunity to raise awareness on the disease and on research conducted in this area. In Luxembourg, the prevalence of hepatitis C is estimated to 0.7% in the resident population. The country makes considerable efforts to reduce the disease burden among the most vulnerable population: drug users with unsafe drug injection practices. A recent pilot project aiming at expanding screening and care of hepatitis through interventions in harm reduction centres was selected as a best practice example by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA).

Hepatitis C is a disease of viral origin that is characterised by an inflammation of the liver. The hepatitis C virus (HCV) can cause both acute and chronic hepatitis. The severity of the disease can range from mild symptoms lasting a few weeks to a serious, long-lasting illness. It can develop into chronic cirrhosis and liver cancer if not diagnosed early and treated adequately. A vaccine is available against hepatitis A and B, but not yet against hepatitis C, which is considered to be the most dangerous form.

Pilot study in harm reduction sites

EMCDDA, which is reporting on a regular basis on drug-related infectious diseases in Europe, has selected innovative approaches from different countries for delivering HCV testing and care to people who inject drugs to present them as best practice cases. Among these is Luxembourg’s model of care, developed jointly by the Infectious Diseases Unit at LIH’s Department of Infection and Immunity, and the National Service of Infectious Diseases of the Centre Hospitalier de Luxembourg (CHL). It consists in bringing HCV testing and treatment closer to the clients of harm reduction services to reduce HCV burden and transmission and improve treatment follow-up.

The pilot intervention study named HCV-UD was conducted from 2015 to 2018 at three harm reduction centres and at the national supervised drug consumption facility Abrigado. From the 368 drug users who participated, 48 received a direct-acting antiviral treatment. In total, 55 were followed for their HCV infection. “The study demonstrates the feasibility and acceptability of HCV testing implemented in harm reduction centres among drug users, including the proactive screening of this population,” states Dr Carole Devaux, Head of LIH’s Infectious Diseases Unit.

Due to its success, the HCV-UD project has been further expanded to organisations taking care of homeless people, medical offices of clinicians prescribing treatment substitution and in the other drug consumption room opening end of July in Esch-sur-Alzette.

Establishing recommendations

The pilot study was very beneficial in the national context. “The study will shape the new national drug plan 2020-2025 that is currently being elaborated”, underlines Dr Devaux. Under guidance of the EMCDDA and the EMCDDA Luxembourg Focal Point (PFLDT - Point Focal Luxembourgeois de l’Observatoire Europeen des Drogues et des Toxicomanies) from the Directorate of Health, a roundtable was also organised in January 2019 with 21 key stakeholders in order to reach consensus regarding the main barriers to HCV testing and access to care among people who inject drugs. The roundtable assembled, amongst others, experts from different treatment institutes, the national drug consumption facility, and the National Service of Infectious Diseases. A report is currently in preparation outlining the main facilitators and recommendations for HCV testing and access to treatment resulting from the roundtable. It will be disseminated among policy makers and professionals in the field.

World Hepatitis Day

Every year on 28th July is the World Hepatitis Day, coordinated by the World Hepatitis Alliance. This event aims to create awareness, prevent infection and fight against the disease. For this occasion, staff members of LIH, CHL, the Ministry of Health and the Red Cross HIV Berodung will be present on 26th July at Abrigado to inform on the HCV burden and propose rapid screening in the co-called DIMPS van (Mobile Intervention Device for the Promotion of Sexual Health). In addition, people will be invited to participate in the HCV-UD follow-up study.

A press release on the World Hepatitis Day in Luxembourg is available on the portal.