Implementation of testing, diagnostic and treatment of hepatitis C in low-threshold drug help facilities in Germany - a cross-sectional survey

Background AIDS and drug aid facilities offer a low-threshold access for people with injecting and other forms of drug use and thus play a central role in reducing hepatitis C virus (HCV) infections in this high-risk group. The aim of this study is to describe the provision and barriers of HCV-specific measures in facilities with low-threshold services for drug users in Germany. Method The cross-sectional survey addressed facility structures, availability of HCV-specific measures (prevention, testing, diagnostics, therapy), structural, facility-related and patient-related barriers. The allocation of consumer paraphernalia was used as a criterion for the selection of facilities with low-threshold access for people with injecting and other forms of drug use. The data analysis was carried out descriptively by summarizing and analyzing facilities based on their characteristics. Results Of the 380 facilities contacted, responses from 135 facilities with low-threshold access for people with injecting and other forms of drug use were included in the analysis. Most of the facilities offer information on "safer use" (98.5%) and HCV-counselling (87.4 %). Around 28% of the facilities have HCV antibody or rapid tests available. 40% and 64.4% of all facilities stated that clients with a positive antibody test result or with a corresponding diagnosis (e.g. chronic HCV infection) can be referred to medical care. Insufficient funding and client-related barriers (e.g. lack of reliability) were mentioned as the main barriers to improving the implementation of HCV-specific measures. Conclusions While general HCV-prevention measures are an integral part of low-threshold services for drug users in Germany, the availability and uptake of HCV testing and HCV care services for people with injecting and other forms of drug use is not sufficient to significantly reduce HCV infections in this high-risk group. In addition to adequate funding, client-centered interventions are needed to improve the uptake of such offers.