Module 2: HCV transmission and risk prevention - section 2

In this document:

 HCV prevention interventions

Activity: Presentation and small group work
Section Time: Approximately 30 minutes

This section provides participants with the opportunity to identify the interventions for PWID required to reduce HCV transmission and why these are not always optimised.

Open this section by showing Slide 2.7 (HCV prevention strategy limitations) to the large group: 

Facilitate a short discussion by:

  • Exploring participant's thoughts on the statement.
  • Establishing how this reflects local situations and prevention strategies
  • Highlight how integrated responses are required to optimise HCV transmission prevention e.g. NSP and OST
Supporting content:

Compared with responses to HIV the effectiveness of harm reduction measures on the prevention of HCV has been explored to a lesser extent, and their effectiveness at reducing viral transmission seems to be lower. This is certainly due in part to the efficiency with which HCV spreads through the sharing of injecting equipment, and in part to the fact that rarely all associated risks are addressed. Although there are some commonalities in injecting behaviours across populations, injecting practices notably vary and can be individualised according to the situational and environmental factors that prevail within drug using communities.

Research data from around the world provides guidance on interventions for preventing and reducing further incidence of HCV among PWID, including the reduction of the risks for HCV transmission and the prevention of progression of the virus. Although controlling HCV in PWID proves to be difficult, the delivery of various prevention and harm reduction intervention strategies simultaneously through integrated responses seems to increase opportunities for reduction in HCV transmission. The two most important interventions appear to be NSPs and OST, ideally provided in combination.

For this activity ask the participants to form small groups and using Slide 2.8 (Group work) ask them to list on flip chart paper the main interventions that reduce HCV transmission among PWID:

Allow 10 minutes for small group work before asking for feedback in the larger group. Facilitate a 10 minute discussion, which clarifies that:

  • Good NSP coverage with a range of injecting equipment and optimised OST are the two most important factors for effective HCV prevention
  • Other interventions can augment or complement programmes including:
    • Education and outreach to PWID
    • Low threshold testing
    • Drug consumption rooms
    • Peer-led programmes
    • Interventions that reduce injecting e.g. foil distribution

Once feedback has finished, showing Slide 2.9 (Group work) ask the large group to briefly brainstorm answers to the question and record answers on flipchart:

Stimulate discussion and ensure there is reference to:

  • Public injecting and homelessness associated with distinct risks
  • Prison injecting with frequently shared equipment
  • Limited access to NSP and sterile injecting equipment
  • Poor injecting practices established at initiation
  • Lack of knowledge around injecting hygiene
  • Stigma and persecution
  • Batch preparation
  • Accidental sharing
  • Cultural norms around drug preparation and administration
  • Situational factors such as withdrawal, increased urgency (crack injection)
  • Being injected by others
  • Relationship sharing norms
Supporting content:

Ethnographic studies of injecting drug use show that there are a range of factors that contribute to high risk injecting behaviours. Direct and indirect sharing are common and are likely to be exacerbated by situational and environmental factors where loss of hygiene control over the injecting process tends to be evident. Although prevention messages are central to harm reduction interventions, for them to be effective they need to be applied to the context of an individual's injecting situation

Understanding people's injecting practices in detail, their individual circumstances and the context of injecting, is an important step in helping PWID identify risks. Assessment informs the basis for interventions that can support them by educating and reinforcing the adoption of the least harmful practices in any given injecting situation. Adaptations are required to facilitate safer injecting in sub-optimal conditions and this requires skilled and innovative approaches with PWID.

The following film can be shown to support the last activity after feedback has been taken. It is used to give an example of how educational tools can support PWID in adopting safer practices.

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