This document summarizes a presentation given by Anastasia Pharris of the European Centre for Disease Prevention and Control on infections among people who inject drugs. It finds that over 30,000 new HIV diagnoses in Europe in 2016 were due to injecting drug use, with most cases concentrated in Eastern Europe. While harm reduction efforts have made progress in some countries, people who inject drugs still face high burdens of HIV, hepatitis C, and other infections. The presentation calls for improved testing, treatment, and prevention programs targeting this group.

1. Infections among people who inject drugs --
problem solved?
Anastasia Pharris, European Centre for Disease Prevention and Control (ECDC)
European Harm Reduction Conference
Bucharest, 21 November 2018

2. Source: ECDC/WHO (2017). HIV/AIDS Surveillance in Europe 2017– 2016 data
East
80%
≈ 128,000
people
Centre
4%
≈ 5,800
people
West
16%
≈ 26,000
people
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>160 000 persons were diagnosed with HIV in
the WHO European Region in 2016

3. Source: ECDC/WHO (2017). HIV/AIDS Surveillance in Europe 2017– 2016 data
East
97%
≈ 29 600
PWID
Centre
0.5%
≈ 160
PWID
West
2.5%
≈ 760
PWID
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>160 000 persons were diagnosed with HIV in
the WHO European Region in 2016
≈ 30 500 new
diagnoses due to
injecting drug use

4. Source: ECDC/WHO (2017). HIV/AIDS Surveillance in Europe 2017– 2016 data
@ECDC_HIVAIDS
Transmission risk pattern differs by sub-region
MSM
IDU
HETERO
MSM
IDU
HETERO
MSM
IDUHETERO
45% born
abroad
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5. Source: ECDC/WHO (2017). HIV/AIDS Surveillance in Europe 2017– 2016 data
The majority of new HIV infections
in the Region are in a few
countries

6. Characteristics of new HIV diagnoses
attributed to injecting drug use, 2016
• 83% male (range 0-62%)
• 5% migrant
• 49% 30-39 years at diagnosis
6
Source: ECDC/WHO (2017). HIV/AIDS Surveillance in Europe 2017– 2016 data

7. 7
HIV diagnoses among people who
inject drugs, by WHO sub-region
Source: ECDC/WHO (2017). HIV/AIDS Surveillance in Europe 2017– 2016 data

8. 8
HIV diagnoses among people who
inject drugs, by WHO sub-region
Athens
outbreak
Bucharest
outbreak

9. @ECDC_HIVAIDS

10. Proportion of persons diagnosed late*, by
demographic, WHO European Region, 2016
Source: ECDC/WHO (2017). HIV/AIDS Surveillance in Europe 2017– 2016 data
*Diagnosed late=CD4<350 cells/mm3 at diagnosis
51%
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11. Fast Track Targets by 2020
73%
of all people living
with HIV
VIRALLY
SUPPRESSED
=
Target 1 Target 2 Target 3
diagnosed with HIV
ON ART
living with HIV
DIAGNOSED
on ART
VIRALLY
SUPPRESSED
Overall target
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12. Continuum of care for PWID, 2018
100%
86%
78% 75%
100%
90%
50%
39%
100%
84%
75% 71%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
LivingwithHIV
Diagnosed
ReceivingART
Virallysuppressed
LivingwithHIV
Diagnosed
ReceivingART
Virallysuppressed
LivingwithHIV
Diagnosed
ReceivingART
Virallysuppressed
MSM (n=10) PWID (n=8) Migrants (n=5)
Source: ECDC. Dublin Declaration monitoring 2018; validated unpublished data. @ECDC_HIVAIDS

13. 100%
86%
78% 75%
100%
90%
50%
39%
100%
84%
75% 71%
100%
87%
77%
70%
100%
86%
75%
67%
100%
88%
81%
76%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
LivingwithHIV
Diagnosed
ReceivingART
Virallysuppressed
LivingwithHIV
Diagnosed
ReceivingART
Virallysuppressed
LivingwithHIV
Diagnosed
ReceivingART
Virallysuppressed
MSM (n=10) PWID (n=8) Migrants (n=5)
Source: ECDC. Dublin Declaration monitoring 2018; validated unpublished data. @ECDC_HIVAIDS
Continuum of care for PWID, 2018
Gaps in access to
antiretroviral
treatment among
PWID

14. 0 20 40 60 80 100
People who inject drugs
Prisoners
People living with HIV
Haemodialysis patients
Migrants
Recipients of substances of human origin
Healthcare workers
General population
Men who have sex with men
Range of anti-HCV prevalence (%)
Source: ECDC reports - Hepatitis B and C epidemiology in Selected Populations and Systematic review on Hepatitis B and C prevalence in the
EU/EEA https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/systematic-review-hepatitis-B-C-prevalence.pdf
Hepatitis C prevalence in key populations
groups in EU/EEA countries
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15. Hepatitis C prevalence among people who
inject drugs, by age, 2015 to 2016
Source: EMCDDA, European Drug Report, http://www.emcdda.europa.eu/data/stats2018/drid @ECDC_HIVAIDS

16. Hepatitis B prevalence among key population
groups in EU/EEA countries
0 20 40
People living with HIV
Prisoners
Migrant populations
People who inject drugs
Haemodialysis patients
Recipients of substances of human origin
General population
Healthcare workers
Men who have sex with men
Range of HBsAg prevalence (%)
Source: ECDC reports - Hepatitis B and C epidemiology in Selected Populations and Systematic review on Hepatitis B and C prevalence in
the EU/EEA https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/systematic-review-hepatitis-B-C-prevalence.pdf @ECDC_HIVAIDS

17. Proportion of new diagnoses attributed to
injecting drug use
50%
37%
10% 5%
Among people with known route of transmission, unknown route of transmission is excluded here.
Source: ECDC (2018). Surveillance of hepatitis B and C in the EU/EEA – 2016 data. Source: ECDC/WHO
(2017). HIV/AIDS Surveillance in Europe 2017– 2016 data @ECDC_HIVAIDS

18. • Skin and soft tissue infections caused by
Staphylococcus aureus and streptococcal infections
(e.g. endocarditis, necrotising fasciitis)
• Tuberculosis
Heighted risk among PWID for other infections
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19. European guidance on
prevention of infections in
people who inject drugs
• Vaccination
• Testing
• Infectious disease treatment
• Health promotion
• Targeted delivery of services
• Injection equipment
• Drug dependence treatment
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20. 589 000 people in prison in the EU
(1st September 2016)
IE UK
IT
DE
FR
NO
SE
PL
E
CZ
HU O
B
EL TR
Number of prisoners per
100.000 population
EU-28: 112
Russia: 425
USA: 716
Source: SPACE 2017 – Council of Europe
• ~ 1900 prisons
• Average sentence 8
months
• 16% non- nationals
• High burden of blood-
borne viruses (BBV)
• Setting of increased BBV
transmission
• Opportunity to address
health needs of
underserved group
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21. 21
EMCDDA-ECDC Guidance on prevention and control
of communicable diseases in prison settings
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22. November 2011
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23. •Risk assessment updated and published November
2013
•Main finding: continued outbreaks and deficits in harm
reduction coverage in some EU/EEA countries
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24. Indicators of HIV trend, transmission risk and
prevention coverage in 30 EU/EEA countries, 2010–2013
AT BE BGHR CY CZ DK EE FI FR DE EL HU IS IE IT LV LT LU MT NLNO PL PT RO SK SI ES SE UK
HIV trend
Transmission
risk
OST
coverage
NSP
coverage
NO ALERT – no evidence for increase
CONCERN - Subnational increase in HIV/HCV prevalence and/or transmission risk or consistent but non-significant
ALERT – evidence for significant increase in case reports or HIV/HCV prevalence and/or increase in transmission risk and/or low
intervention coverage.
Information unknown/not reported EMCDDA/ECDC.
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25. HA-REACT
• October 2015 – January 2019
• 22 partners from 18 countries
• Work packages
• Testing and linkage to care
• Scaling up harm reduction (PS 1)
• Harm reduction and continuity of care in prisons (PS 17)
• Integrated care (PS 7)
• Sustainability and long-term funding
• Focus countries: Latvia, Lithuania and Hungary; Czech Republic
and Poland
http://www.hareact.eu/en
The Joint Action on HIV and Co-infection Prevention and Harm Reduction (HA-REACT)
addresses existing gaps in the prevention of HIV and other co-infections, especially
tuberculosis (TB) and viral hepatitis, among people who inject drugs (PWID).
@ECDC_HIVAIDS

26. Conclusions
• Despite improvements in some countries, people who
inject drugs still face a disproportionate burden of
infections, including HIV and viral hepatitis
• Efforts to improve late diagnosis and access to
effective treatment for this group will improve
outcomes
• Outbreaks of HIV provide lessons for enhanced
prevention
• Joint European efforts can help accelerate progress
and facilitate sharing of best practices
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27. Thank you!
Dagmar Hedrich
Erika Duffell
Lina Nerlander
Teymur Noori
Rosalie Hayes
Yusef Azad
Alison Brown
Valerie Delpech
anastasia.pharris@ecdc.europa.eu
@ECDC_HIVAIDS
@ECDC_HIVAIDS