HA-REACT Joint Action WP4 Testing and Linkage to care Methods: Trainings in two Focus Countries (Latvia and Hungary) Informational materials for PWUD Training Manual on HIV and HCV rapid testing E-learning course https://harmreduction.eu/

- High prevalence of HIV and HCV cases among PWUD NPS usage Background: - High prevalence of HIV and HCV cases among PWUD NPS usage Limited access to the medical system Low knowledge about own infectious status The project offers: Access to the testing and counselling services close to the scene Anonymous and free of charge Trustful environment Access to additional services on site Although, numbers of new HIV infections in people who inject drugs have stabilised in most western European countries, it remains a big problem in eastern Europe. Number of new HCV cases in PWID grows rapidly, which is also directly connected to the switch in drugs used and injecting practises connected to the NPS. Active drug users are still facing criminalisation and discrimination and therefore very limited access to the medical system. The HA-REACT project offered pwud in Hungary and Latvia access to rapid HIV and HCV testing in low threshold settings. Great part of the testing was on pre and post test counselling, which was designed in a form of “risk awareness”. We also put a big effort to improve linkage to care for those tested positive.

Low threshold settings involved: Latvia 8 cities, 16 NGOs: Hungary 5 cities, 13 NGOs:

Rapid tests used in the project: Latvia (Fingers/ck Whole Blood specimen): CHiL HСV СHiL HIV Hungary (oral tests): HCV OraQuick HIV OraQuick Rapid tests performed by: Latvia: nurses (medical education required) Hungary: social workers and peers (training on rapid testing required)

Latvia: Hungary:

Governmental restrictions towards harm reduction services Hungary. 01 Governmental restrictions towards harm reduction services Low access to PWUD 02 Even though, a shift in drug use from heroin to NPS and amphetamine increased the amount of needles needed as well as the number of individuals seeking help at low threshold settings, the key needle exchange programs in Budapest have been closed in recent years due to political pressure. now there are 3 smaller programs remained with low distribution. Social workers and even peers understand harm reduction as abstinence at the first place, which leads to additional barriers for active PWUD to enter the services. DAA is available and should be accessible for everybody in Hungary, though NGOs participated in the project reported that PWUD are excluded and discriminated by medical stuff. 03 Growing number of new HIV/HCV infections

Latvia In year 2018. new upgrades were implemented in HIV/AIDS policy: the threshold for HIV patients’ treatment was cancelled, a special form for sending a HIV positive patient directly from HPP to infectologist was established. In the nearest future, we should think about possible cost relief for patients. Ministry of Health is currently working on new HIV patient register. Also the ministry believes that Centre for Disease Prevention and Control of Latvia should purchase social mentoring services from HIV prevention points.

Conclusions: Rapid testing must be offered in low threshold settings. Harm reduction programs are an important way to increase HIV/HCV prevention among PWUD. Offer maximum at one place: Consultation-Testing-Treatment Workers must update clients on new HCV treatment options Additional funding to improve linkage to care needed

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