Module 3: HCV prevalence and course of HCV infection - section 2

In this document:

HCV transmission and injecting drug using populations

Activity: Presentation, group work and discussion
Section Time: Approximately 20 minutes

This section will start to explore the association between HCV transmission and injecting drug use and highlight how PWID are both the most at-risk population and the group with the highest prevalence - in some cases as much as 60–90% - across much of Central and Eastern Europe.

Show Slides 3.6 (HCV and injecting drug use in Central and Eastern Europe) and Slide 3.7 (HCV and prisoners across Central and Eastern Europe) to illustrate HCV prevalence among PWID in both community and custodial settings:



Facilitate discussion and feedback by:

  • Conveying that, overall, although there is little systematic and updated data on HCV prevalence across the region, data available demonstrates that the scale of HCV prevalence among PWID is high.
  • The slides are used to outline regional trends. At this stage you may encourage participants to make comparisons with the local situation and engage them as themes emerge as the slides are presented.
  • Highlight particular risks faced by PWID in prison settings – what is occurring locally?
  • Emphasising the need for preventative interventions for all PWID (in community and prison settings) for both those newly initiated into injecting but also to those injecting over extended periods and years as prevalence increases over time.
  • Discussion points should be kept short as the exercise following the presentation is intended to allow further exploration and representation of local injecting drug use and HCV situations.

Assemble small groups; show Slide 3.8 (Group work) and each group to record on flip charts answers to the following questions:


Allow 10 – 15 minutes for consideration and answering before convening the large group for feedback and discussion.

Facilitate discussion and feedback by:

  • Ensuring participants have considered estimates of the number of local PWID
  • They are aware of local HCV prevalence rates amongst PWID
  • Identifying and accounting for local/countrywide variations
  • Establishing infection rates among their prison population
  • Being prepared to ask about other marginalized groups that may be at particular risk. It would be expected that by the end of this section for participants to establish a consensus, supported by established local and regional data, around PWID and HCV rates.
  • However, it may be the case that local epidemiological data is unavailable or poor quality. In these cases encourage participants to pay particular attention to examples where they may be able to advocate for improvements.
Supporting content:

PWID are especially susceptible to HCV because sharing of injection equipment, certainly the most efficient transmission vector, regularly occurs among members of this population. HCV infection spreads rapidly once introduced into a drug using community and where access to sterile injecting equipment is insufficient or unavailable. HCV prevalence among adult PWID currently exceeds 50% in many countries around the world, including some of the most populous. A recent report estimated that 92% of PWID in India are infected with HCV, for example, as are 85% in Germany, up to 80% in the United States, and as many as 70% in Brazil.

The situation is arguably worse in countries where a higher share of the population injects drugs, even if the absolute numbers of HCV-positive individuals currently are lower. Countries in this category include Thailand (where 90% of PWID are thought to have HCV) and several others in Eastern Europe and Central Asia. In Russia, for example, an estimated 90% of the country’s 2 million PWID have HCV; in Ukraine, meanwhile, between 70 and 90% of the country’s 400,000 or so PWID are living with HCV. High HCV prevalence rates among PWID are also found in several other countries in the region, including Lithuania (95%), Estonia (90%), and Kazakhstan (66%).

While high prevalence levels of HIV infection are only found in some EU Member States, viral hepatitis and, in particular HCV are highly prevalent in PWID across Europe. HCV antibody levels among national samples of injecting drug users in 2007–08 vary from about 12 % to 85 %, with eight out of 12 countries reporting levels in excess of 40 % (EMCCDA 2010)

According to various estimates, there could be between 2.1 and 3.3 million PWID in the 13 countries of the region. Studies among drug injectors from these countries show quite diverse prevalence rate of HCV, varying from 14–97% in different settings. The rates for HCV are commonly higher in the Eastern part of the region, with the highest rates - from 70% to over 90% - reported in Estonia, Lithuania, Russia and Ukraine.

Significantly lower rates of HCV are reported from countries of Central Europe where HIV prevalence among PWID is also low –Czech Republic, Hungary, Romania, Slovenia and Slovakia. However, HCV prevalence of more than 60% was found in studies from Bulgaria, Poland and Romania, showing that in fact HCV prevalence is high among PWID compared to HIV prevalence throughout the region.

(Hepatitis C Among Injecting Drug Users in the New EU Member States and Neighbouring Countries: Situation, Guidelines and Recommendations, EHRN 2007)

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