Integrated Hepatitis Care
Arud is an NGO which, since its beginnings in 1991, has run one of the largest outpatient addiction units in Europe offering integrated care for about 2,500 patients. Besides the provision of opioid replacement therapy, the centre’s 140 employees include psychiatrists, psychologists, internal medicine specialists, infectious disease specialists, social workers, nurses and peer workers.
The integrated care model includes infectious disease prevention with injection and sniffing paraphernalia distribution, and peer-to-peer counselling, alongside medical care. Hepatitis B and C care is offered, including counselling, testing, treatment and follow-up care.
Access and uptake of viral hepatitis services is low among people who use drugs despite the high prevalence among this group. Arud’s main goal is to offer accessible services. This is why the organisation provides a full range of viral hepatitis and HIV care in a low-threshold accessible addiction outpatient unit. HIV, Hepatitis B and C patients do not have to be referred anywhere else. From diagnosis to follow-up care, all services are provided and can be accompanied by psychiatric and general medicine services.
Research shows very favourable treatment outcomes for hepatitis C and very low reinfection rate among patients treated at Arud. The organisation is close to achieving the elimination goal for HCV, HBV and HIV.
Learnings / Recommendations
The integration of harm reduction and viral hepatitis/HIV services in the same decentralised setting accelerates progress towards elimination amongst people who use drugs. Such a micro-elimination approach, offering peer-counselling, education and prevention materials, as well as diagnosis and treatment to patients who would be unable to attend traditional care setting, significantly improves outcomes and avoids reinfection.
Arud has financed its care model without public funding since its inception. Financing is mainly provided through the billing of medical services to health insurance companies. For developing new projects and for research work, funding comes primarily from foundation money and grants from the private sector.
Philip Bruggmann, Arud Centre for Addiction Medicine