Elimination barometer on viral hepatitis among people who inject drugs in Europe

Page last updated: July 2021

About the elimination barometer

 

The elimination barometer for hepatitis B and C among people who inject drugs is designed to support countries affiliated to the EMCDDA in monitoring their progress towards the Sustainable Development Goal 3.3 and the elimination of viral hepatitis as a major public health threat by 2030. Under five building blocks, it brings together 10 epidemiological indicators (2019 or latest) and corresponding 2020 targets related to people who inject drugs for the EU, Norway and Türkiye, following the WHO monitoring frameworks (WHO, 2016b, 2017).

For each indicator, the EMCDDA elimination barometer provides:

  • Contextual information, references and definitions
  • An infographic showing national data
  • The related 2020 WHO target
  • An achievement status: how many countries have reached the target
  • The corresponding data tables
Monitoring and evaluation framework: indicators to monitor and evaluate the health sector response to viral hepatitis B and C among people who inject drugs
HCV elimination iniatiative for people who inject drugs. Main building blocks:1.ninformation on the situation. 2. Is there an inclusive policy? 3. Prevention including vaccination. 4. Testing and treatment. 5. What is the impact?

Adapted from Monitoring and evaluation for viral hepatitis B and C: recommended indicators and framework, World Health Organization (2016).

The methods and data sources of the elimination barometer are described in more detail in a technical report (EMCDDA, 2019b). The EMCDDA is conducting this monitoring with the drug-related infectious diseases (DRID) network in close collaboration with ECDC, the EU agency that monitors the overall responses to the hepatitis B and C epidemics in EU/EEA Member States (ECDC, 2020c, 2021b).

Why it matters

In 2016, there were an estimated 10 million people in the European Union (EU) and European Economic Area (EEA) living with chronic hepatitis B or hepatitis C, including many with an undiagnosed infection (ECDC, 2016). Chronic viral hepatitis can result in serious liver diseases such as cirrhosis and cancer. In that year, the World Health Assembly endorsed the first global health sector strategy on viral hepatitis (WHO, 2016a). The aim of the strategy is to eliminate viral hepatitis as a major public health threat by 2030.

In Europe, people who inject drugs (PWID) constitute a key population for the elimination of these infectious diseases, both in terms of transmission (requiring higher levels of combined prevention) and burden (requiring better access to treatment). The year 2020 was marked by the COVID-19 pandemic, which has posed many challenges for health systems across Europe, including many harm reduction services already in the front line of hepatitis prevention and control. The year was also significant for the hepatitis action plan, which set important milestones and corresponding targets for 2020. 

Overview

What can we say from the 2019 monitoring data on people who inject drugs?

  • Overall result: The region has not reached the 2020 WHO viral hepatitis elimination targets for people who inject drugs.
  • Context and need: The prevalence of HCV and HBV remains very high among people who inject drugs, exposing them to a high yet preventable morbidity and mortality burden through serious liver diseases such as cirrhosis and cancer.
  • Policy: A majority of EU Member States have or are in the process of adopting inclusive national hepatitis plans or policies, showing encouraging political committment.
  • Prevention: Only 2 countries had data to document they reached harm reduction coverage targets in 2019, and in 6 countries HBV vaccination was still not accessible in prison to people who inject drugs, stressing sub-optimal provision of cost-effective interventions.
  • Testing and treatment: Twelve countries reported that less than half of the people who inject drugs entering drug treatment had been tested for HCV in the last 12 months, and 7 countries still imposed restrictions on access to direct-acting antiviral agents for people who inject drugs in 2019, underlining inequities in the continuum of care.
  • Impact: HCV transmission among people who inject drugs remained high between 2015 and 2019, stressing the urgent need to scale-up access to integrated and stigma-free prevention and care among this population.

Level of achivement for each indicator among people who inject drugs

Select an indicator

Indicator:
Data on key population size

Related 2020 target: data available on key population size to inform disease burden estimates.

Achievement status: 16 countries have recent data on the number of people who inject drugs.

Indicator:
Data on HCV antibody prevalence

Related 2020 target: data available on HCV antibody prevalence among people who inject drugs to inform disease burden estimates.

Achievement status: 25 countries have recent data on anti-HCV prevalence among people who inject drugs.

Indicator:
Data on HCV RNA prevalence

Related 2020 target: data available on the prevalence of viraemic HCV infection among people who inject drugs to inform disease burden estimates.

Achievement status: 6 countries have recent data on HCV RNA prevalence among people who inject drugs.

Indicator:
Data on HBV prevalence

Related 2020 target: data available on the prevalence of viraemic HBV infection among people who inject drugs to inform disease burden estimates.

Achievement status: 18 countries have recent data on HBsAg prevalence among people who inject drugs.

Indicator:
Inclusive national policy

Related 2020 target: costed and funded inclusive national hepatitis policy adopted.

Achievement status: 19 countries have adopted an inclusive national hepatitis policy or plan.

Indicator:
Needle and syringe provision (NSP) and opioid substitution treatment (OST) coverage

Related 2020 target: number of syringes distributed by person who injects drugs = 200, proportion of high-risk opioid users in opioid substitution treatment = 40 %.

Achievement status: 2 countries have reached the combined prevention targets.

Indicator:
HBV vaccination availability in prisons

Related 2020 target: HBV vaccination is available to people who inject drugs in prison as part of a comprehensive package of harm reduction services.

Achievement status: 18 countries have HBV vaccination programmes targeting people who inject drugs in prisons.

Indicator:
HCV testing coverage

Related 2020 target: 50 % of people who are chronically infected with viral hepatitis are diagnosed.

Achievement status: 9 countries reported that >50 % of people injecting drugs entering drug treatment had been tested for HCV in the last 12 months.

Indicator:
Direct-acting antiviral agents (DAA) treatment availability without restrictions

Related 2020 target: Treatment, in line with international standards, to be available and affordable for all.

Achievement status: 21 countries have no clinical or financial restriction linked to drug use for DAA access.

Indicator:
HCV Incidence proxy over time

Related 2020 target: 30 % reduction in the number of new chronic hepatitis C infections (baseline: 2015)

Achievement status: No country has evidence of significant reduction in HCV transmission among people who inject drugs in 2015-19

The source data table for the main information in the interactive maps presented here is available in the country-by-country overview table on this page.

What are crucial data gaps for viral hepatitis monitoring among people who inject drugs?

While there has been progress since the last monitoring round, indicators from all five building blocks still require higher quality and completeness to efficiently guide and assess public health interventions. Four areas require particular attention for people who inject drugs:

  • Population size estimates, for burden estimates and prevention coverage
  • Prevalence of viraemic/chronic HCV infection from observational studies
  • Continuum of care data
  • Data on mortality attributable to HCV and HBV infections

The EMCDDA is working closely with the DRID network and its partners to update the elimination barometer on a yearly basis and monitor progress towards the Sustainable Development Goals related to people who inject drugs. Monitoring data, reports, guidance and activities of the DRID network can be found on the drug-related infectious diseases hub page.

Context and need

Number of people who inject drugs and prevalence of injecting drug use per country

Knowing the size of the population of people who inject drugs living in each country is necessary in order to quantify the burden of disease associated with injecting drug use and to plan harm reduction and health services accordingly. The main risk factor for blood-borne infections – including HBV and HCV – among this group is the sharing of needles, syringes and other drug equipment. The injection of stimulant drugs has been associated with higher-risk practices and blood-borne virus outbreaks (Arendt et al., 2019; Giese et al., 2015; Hanke et al., 2020; McAuley et al., 2019; Tarján et al., 2017). And while evidence from drug treatment centres suggests that injecting drug use is declining among heroin clients in the European Union (EMCDDA, 2020b), an EMCDDA study looking at the residual content of used syringes in sentinel cities suggests that stimulant injecting is common among people who inject drugs in Europe (EMCDDA, 2019a).

People who inject drugs are defined here as those aged between 15 and 64 years who have injected any psychoactive substance not according to medical prescription in the last 12 months. The prevalence of injecting drug use in a given country is calculated as the number of people who inject drugs estimated for a given year divided by the population aged 15 to 64 years and multiplied by 1 000, so that it is expressed per 1 000 population. Population data were provided by (Eurostat, 2020). The number of people who inject drugs is estimated through indirect statistical methods such as capture-recapture studies (Raag et al., 2019) and treatment multiplier studies (Larney et al., 2017), and comes with a high degree of uncertainty.

Figure 1. Estimated number of people who inject drugs and prevalence of injecting drug use by country, 2019 or latest available data

Method of estimation
TM: treatment multiplier; CR: capture-recapture; TP: truncated Poisson; CM: combined methods; HM: HIV multiplier; MM: mortality multiplier; MIM: multivariate indicator method; OT: other

The source data for this graphic is available in Table 1 on this page.

The total number of people who inject drugs for the 27 EU Member States and Norway in 2019 was estimated by imputing the prevalence of injecting drug use for countries with missing data using estimates from EU countries with available data. Based on available national estimates from 2012-19, the prevalence of injecting drug use was 1.95 per 1 000 population aged 15-64 years (UI: 1.71-2.19), corresponding to an estimated 581 000 people who inject drugs living in the EU and Norway in 2019.

Prevalence of HCV antibodies and current HCV infections among people who inject drugs

The prevalence of antibodies to HCV (anti-HCV) among people who inject drugs indicating present or past infection, either cleared or treated is estimated from seroprevalence studies (well-designed observational studies) or routine diagnostic tests offered in drug treatment centres or low-threshold services (programme data), reported to the EMCDDA by EU Member States, Norway and Türkiye.

As the number of patients successfully treated with antivirals will increase, antibody prevalence will have more limited utility to measure the burden of HCV. A better indicator is the prevalence of chronic and/or current infections among people who inject drugs, using HCV RNA (or antigen) tests to confirm the presence of the virus (WHO, 2018).

Figure 2. Prevalence of HCV antibodies among people who inject drugs, by country, 2019 or latest available data

The level of evidence is assessed separately for seroprevalence studies (SP) and routine diagnostic tests (DT), based on the case definition for people who inject drugs, sample size, type of settings, number of sites, type of biological sample. SP are also assessed for sampling method; and DT for timeliness, periodicity and geographical coverage.

The source data for this graphic is available in Table 2 on this page.

Figure 3. Prevalence of current HCV infection (HCV RNA+) among people who inject drugs, by country, 2019 or latest available data

The level of evidence is assessed separately for seroprevalence studies (SP) and routine diagnostic tests (DT), based on the case definition for people who inject drugs, sample size, type of settings, number of sites, type of biological sample. SP are also assessed for sampling method; and DT for timeliness, periodicity and geographical coverage.

The source data for this graphic is available in Table 3 on this page.

Prevalence of current HBV infections among people who inject drugs

HBV infection is less common than HCV infection among people who inject drugs, but is still much higher than in the general population. This is so, despite the availability of an effective vaccine, which is included in the recommended vaccination schedules in most EU Member States (ECDC, 2020d). For HBV, the presence of the HBV surface antigen (HBsAg) indicates a current infection, which may be recent or chronic.

Figure 4. Prevalence of current HBV infection (HBsAg+) among people who inject drugs, by country, 2019 or latest available data

The level of evidence is assessed separately for seroprevalence studies (SP) and routine diagnostic tests (DT), based on the case definition for people who inject drugs, sample size, type of settings, number of sites, type of biological sample. SP are also assessed for sampling method; and DT for timeliness, periodicity and geographical coverage.

The source data for this graphic is available in Table 4 on this page.

National hepatitis policy inclusive of people who inject drugs

The 'inputs' building block of the elimination barometer provides information on the existence of an official national inclusive viral hepatitis policy or action plan, which constitutes an important step towards the implementation of a sustainable elimination strategy (EMCDDA, 2020b). A national policy or plan in which people who inject drugs are explicitly mentioned, with access to harm-reduction, screening and HCV treatment not conditional on abstinence, is defined as being inclusive.

Figure 5. Countries with viral hepatitis policy inclusive of people who inject drugs, 2019

The source data for this graphic is available in Table 5 on this page.

Prevention

Needle and syringe programme and opioid substitution treatment coverage

Prevention is the next key building block of the barometer. Combined high levels of needle exchange coverage and opioid substitution treatment (OST) are cost-effective interventions to reduce the risk of blood-borne infections, including viral hepatitis, among people who inject drugs (Ijioma et al., 2021; Platt et al., 2017). Needle and syringe programme (NSP) coverage is defined as the number of sterile needles/syringes distributed in a year per person who injects drugs. OST coverage is defined as the proportion of people in need of opioid-related treatment who are receiving opioid substitution treatment in a given year. Prevention and harm-reduction measures prevent new infections but also provide an opportunity to reach out to high-risk populations for testing and linkage to care. The 2020 targets are 200 syringes per person who injects drugs per year and 40 % of the population of high-risk opioid users receiving opioid substitution treatment.

Figure 6. Number of sterile syringes distributed per person who injects drugs and proportion of high-risk opioid users in opioid substitution treatment (OST), by country, 2019 or latest available data

The source data for this graphic is available in Table 6 on this page.

Hepatitis B vaccination availability in prison

There is an effective vaccine against HBV, and HBV vaccination campaigns targeting people who inject drugs through appropriate settings are cost-saving (Hu et al., 2008). Due to the high prevalence of HBV infection and drug use among people in prisons, and based on available evidence regarding the implementation of HBV vaccination in prison settings, it is advisable to offer HBV vaccination to people in prison (ECDC and EMCDDA, 2018). It is recommended to offer HBV vaccination at entrance to all individuals with no/unknown vaccination history and/or negative serology, in order to prevent further transmission within the prison setting. The source of the data on the availability of HBV vaccination programmes targeting people who use drugs and are in prison is the EMCDDA’s Insights on prisons (EMCDDA, 2021).

Figure 7. Availability of HBV vaccination targeting people who use drugs and are in prison, by country, 2019-2020

The source data for this graphic is available in Table 7 on this page.

Testing and access to treatment for people who inject drugs

To eliminate viral hepatitis as a public health threat, the WHO 'continuum of care' targets are for 50 % of people who are chronically infected with viral hepatitis to be diagnosed by 2020, 75 % of eligible patients to be receiving treatment and at least 90 % of them to be cured (HCV) or to obtain viral suppression (HBV). Yet, many infections still go undiagnosed and untreated among people who inject drugs. Few countries have a consolidated set of indicators that cover the entire sequence of the continuum of care among people who inject drugs (Aas et al., 2020; ECDC, 2020c; EMCDDA, 2019b, 2020a; Rojas Rojas et al., 2019). The elimination barometer provides a European overview of two pillars of the continuum of HCV care among people who inject drugs: testing and access to direct-acting antiviral (DAA) treatment.

HCV testing coverage among people who inject drugs

The availability of HCV and HBV testing in drug services and in prisons is crucial, but it may not always translate into actual testing. Data on people entering drug treatment, systematically collected by the EMCDDA through the treatment demand indicator (EMCDDA, 2012), includes information on the coverage of HCV testing, defined as the proportion (percentage) of people who inject drugs entering drug treatment who reported having taken an HCV test in the last 12 months. Increasing testing in drug treatment services is one focus of the EMCDDA harm reduction initiative (EMCDDA and Robert Koch Institut, 2018).

Figure 8. Percentage of people entering drug treatment reporting injecting drugs who had been tested for HCV in the previous 12 months, by country, 2019 or latest data available

The source data for this graphic is available in Table 8 on this page.

Absence of clinical and reimbursement restrictions for DAA treatment for people who inject drugs

Direct-acting antiviral agents (DAAs) are an effective treatment option for people who are chronically infected with HCV, including current injecting drug users (Grebely et al., 2018). The goals of DAA therapy are to cure HCV infection in order to prevent complications and mortality, improve quality of life, remove stigma and prevent onward transmission of HCV. The WHO and EASL recommend offering treatment to all individuals diagnosed with HCV infection who are 12 years of age or older (with the exception of pregnant women), irrespective of disease stage (WHO, 2018).

The guidelines also stress that treating people who inject drugs along with provision of harm reduction interventions (to reduce the risk of reinfection) is cost-effective, despite the fact that DAAs remain expensive in many high and upper middle income countries. Testing and linkage to treatment for infected people who inject drugs are therefore core components of the elimination strategy: in addition to the direct beneficial impact for the treated individual, treatment has the potential to reduce transmission in the community (treatment as prevention). The indirect benefits of treatment are increased when the risk of reinfection is reduced, for example in low prevalence settings or in settings with high coverage of harm-reduction measures such as NSP and OST (Martin et al., 2016). However, people with drug or alcohol use dependencies still have to fulfil further criteria (such as being enrolled in OST and/or being abstinent from drugs) before being eligible for DAA access and reimbursement in some EU countries (Marshall et al., 2018).

Figure 9. Existence of restrictive clinical or reimbursement guidelines on access to DAA by people who inject drugs, by country, 2019

Source: EMCDDA and Marshall et al. (2018)

The source data for this graphic is available in Table 9 on this page.

Integrated treatment

A strategy to improve the continuum of HCV care among people who inject drugs is integrated treatment, whereby testing, counselling, treatment and post-treatment follow-up are delivered by multidisciplinary teams in drug services or community care centres for drug users. There is growing evidence of the efficacy of this approach to link people who inject drugs to HCV treatment and to increase adherence (Messina et al., 2020). Correlation – European Harm Reduction Network is providing valuable information reported by harm reduction civil society organisations on several aspects of the continuum of care, including the type of settings where HCV testing and treatment are offered across Europe (Maticic et al., 2020).

Integration is a core principle of the HCV models of care for drug services in Europe documented by the EMCDDA (2019b) and Correlation – European Harm Reduction Network (Schatz et al., 2019). These case studies provide concrete examples to Member States on how to increase access to testing and care for people who inject drugs through drug and harm reduction services.

Twelve countries reported that less than half of people who inject drugs entering drug treatment had been tested for HCV in the last 12 months, and 7 countries still imposed restrictions on access to direct-acting antiviral agents by people who inject drugs in 2019.

Impact

The elimination of viral hepatitis as a public health threat has been defined as a 90 % reduction in the number of new chronic hepatitis B and C infections and a 65 % reduction in the number of deaths by 2030, with milestones for 2020 set as 30 % and 10 % reductions respectively. The baseline is 2015. The indicators proposed by the WHO to monitor the impact of the elimination strategy include the incidence of HCV and HBV infections, and deaths from hepatocellular carcinoma (HCC), cirrhosis and chronic liver diseases attributable to HCV and HBV infections (WHO, 2017).

New notifications of HBV and HCV cases linked to injecting drug use

EU Member States report newly diagnosed cases of hepatitis B or C infection to ECDC using the EU case definitions. The EU case definitions are based on laboratory criteria and differentiate acute from chronic cases (ECDC, 2020a, 2020b, 2020c). When the information is available, the most likely route of transmission is also reported. A case attributed to injecting drug use might be diagnosed in a person who does not inject anymore, so the information refers to ever-injectors (people who have injected drugs at some point in their life). Notification data provide useful information on the distribution and trends in transmission route. In 2019, the percentages of all acute and chronic newly diagnosed HCV cases with known transmission route attributable to injecting drug use in the EU were 50 % (317/630) and 58 % (1542/2665), respectively. For HBV, the percentages were 7 % (40/576) and 3 % (72/2204) (ECDC, 2021a).

A large proportion of acute/chronic hepatitis B and C are asymptomatic so the notification data are strongly influenced by testing trends. The completeness of surveillance data and the availability of information on transmission route also varies by country. Because of the limitations in using notification data to estimate incidence, two related indicators are used to monitor the impact of prevention and treatment of HCV over time: trends in prevalence of anti-HCV in people who have started injecting recently and trends in HCV RNA among people who inject drugs.

Proxies for HCV incidence: trends in anti-HCV prevalence among young/new people who inject drugs

The trend in prevalence of anti-HCV among people who inject drugs aged less than 25 years ('young injectors') and among those who have been injecting for less than two years ('new injectors') can be used as a crude proxy for incidence. Prevalence among this group reflects relatively new transmission (incidence) and it is expected to decrease over time as prevention and treatment coverage increases. If HCV transmission is reduced by prevention measures (NSP, OST but also treatment as prevention), this would affect incidence (the flow of new cases) and would lower the prevalence of anti-HCV among new and young people who inject drugs over time. Trends in anti-HCV prevalence are derived from seroprevalence studies or routine diagnostic tests conducted yearly, using the same protocol over time.

Figure 10. Trends in HCV antibody prevalence among people who inject drugs aged less than 25 years: results from diagnostic tests and seroprevalence studies with national or multi-city coverage, 2013-2019

The source data for this graphic is available in Table 10 on this page.

Figure 11. Trends in HCV antibody prevalence among people injecting drugs for less than 2 years: results from diagnostic tests and seroprevalence studies with national or multi-city coverage, 2013-2019

The source data for this graphic is available in Table 11 on this page.

Trends in prevalence of current HCV infections among people who inject drugs

Another way to monitor the impact of prevention and treatment is to look at the prevalence of current HCV infections among people who inject drugs over time. A scale-up of DAA treatment is expected to reduce the burden of HCV as measured by HCV RNA prevalence over time (Gottfredsson et al., 2019, PHE, 2020). Trends in HCV RNA prevalence are derived from seroprevalence studies or routine diagnostic tests conducted yearly, using the same protocol over time. 

Figure 12. Trends in HCV RNA prevalence among people who inject drugs: results from diagnostic tests and seroprevalence studies with national or multi-city coverage, 2013-2019

The source data for this graphic is available in Table 12 on this page.

Endnotes

Author contributions

European Monitoring Centre for Drugs and Drug Addiction: Thomas Seyler, Bruno Guarita, Isabelle Giraudon, Dagmar Hedrich and André Noor.

The Reitox national focal points and the expert network on drug-related infectious diseases (DRID) network:Irene Schmutterer, Luk Van Baelen, Georgi Shopov, Lara Jezic, Ioanna Yiasemi, Barbara Janikova, Mathilde Pihl Badse, Liis Lemsalu, Henrikki Brummer-Korvenkontio, Anne-Claire Brisacier, Stanislas Spilka, Ruth Zimmerman, Ioanna Siamou, Anna Tarjan, Sean Millar, Barbara Suligoi, Anda Kivite-Urtane, Viktorija Stifanoviciute, Lina Jurgelaitiene, Carole Devaux, Carlo Olivari D' Emanuele, Esther Croes, Hilde Klovstad, Robert Whittaker, Magdalena Rosińska, Karolina Zakrzewska, Domingos Duran, Viviana Manolache, Valentina Stefan, Zuzana Kamendy, Irena Klavs, Marta Molina, Maria Axelsson, Josefine Lundberg Ederth, Seda Kesemen and Peyman Altan

Acknowledgments

Correlation – European Harm Reduction Network: Eberhard Schatz and Rafaela Rigoni

European Centre for Disease Prevention and Control: Erika Duffell, Lina Nerlander and Teymur Noori

World Health Organization Regional Office for Europe: Antons Mozalevskis and Nicole Seguy

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Rojas Rojas, T., Di Beo, V., Delorme, J., Barre, T., Mathurin, P., Protopopescu, C., Bailly, F., Coste, M., Authier, N., et al. (2019), 'Lower HCV treatment uptake in women who have received opioid agonist therapy before and during the DAA era: The ANRS FANTASIO project', International Journal of Drug Policy 72, pp. 61-68.

Schatz, E., Perez Gayo, R. and Raulet, I. (2019), Good practice examples of hepatitis C prevention, testing and treatment by harm reduction services in Europe, Correlation - European Harm Reduction Network, Amsterdam.

Tarján, A., Dudás, M., Wiessing, L., Horváth, G., Rusvai, E., Tresó, B. and Csohán, Á. (2017), 'HCV prevalence and risk behaviours among injectors of new psychoactive substances in a risk environment in Hungary: An expanding public health burden', International Journal of Drug Policy 41, pp. 1-7, doi:10.1016/j.drugpo.2016.11.006.

WHO (2016a), Global health sector strategy on viral hepatitis 2016-2021, World Health Organization, Geneva.

WHO (2016b), Monitoring and evaluation for viral hepatitis B and C: recommended indicators and framework, World Health Organization, Geneva.

WHO (2017), Action plan for the health sector response to viral hepatitis in the WHO European Region, World Health Organization, Geneva.

WHO (2018), Guidelines for the care and treatment of persons diagnosed with chronic hepatitis C virus infection, World Health Organization, Geneva.

Source data

The tables below present the source data used to generate the graphics on this page.

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Overview of situation by country
Country PWID population size anti-HCV prevalence HCV RNA prevalence HBsAg prevalence Inclusive national policy Combined OST/NSP coverage HBV vaccination in prison HCV testing coverage DAA Treatment restriction Impact - incidence proxy over time
Austria No recent data Data available Data available Data available Inclusive policy No data Available On target No restriction No data
Belgium Data available Data available Data available Data available Inclusive policy Below target Available No data No restriction No data
Bulgaria No recent data Data available No recent data Data available No policy No data No data On target Restrictions No significant decrease
Croatia Data available Data available No recent data No recent data Policy in preparation Below target Not available No data Restrictions No data
Cyprus Data available Data available No recent data Data available Inclusive policy Below target No data Below target Restrictions No data
Czechia Data available Data available No recent data No recent data Policy in preparation Below target No data On target No restriction No significant decrease
Denmark No recent data No recent data No recent data No recent data Inclusive policy No data Available Below target No restriction No data
Estonia Data available Data available No recent data Data available No policy No data Available No data Restrictions No data
Finland Data available Data available No recent data No recent data Inclusive policy Below target Available On target No restriction No data
France Data available No recent data No recent data No recent data Inclusive policy Below target Available On target No restriction No data
Germany No recent data Data available Data available Data available Inclusive policy No data Available Below target No restriction No data
Greece Data available Data available Data available Data available Inclusive policy Below target Available No data No restriction No significant decrease
Hungary Data available Data available No recent data Data available Policy in preparation Below target Available No data No restriction No data
Ireland No recent data No recent data No recent data No recent data Inclusive policy No data Available On target No restriction No data
Italy No recent data Data available No recent data No recent data Inclusive policy No data Available Below target No restriction No significant decrease
Latvia Data available Data available No recent data Data available Inclusive policy Below target Not available Below target No restriction No significant decrease
Lithuania Data available Data available No recent data Data available No policy Below target Not available No data No restriction No data
Luxembourg Data available Data available No recent data No recent data Inclusive policy On target Available On target No restriction No data
Malta No recent data Data available No recent data No recent data Inclusive policy No data No data Below target No restriction No data
Netherlands Data available No recent data No recent data No recent data Inclusive policy No data Not available No data No restriction No data
Norway Data available Data available Data available Data available Inclusive policy On target Available No data No restriction No data
Poland No recent data Data available No recent data Data available Policy in preparation No data Available Below target Restrictions No data
Portugal Data available Data available No recent data Data available Inclusive policy Below target Available Below target No restriction No data
Romania No recent data Data available No recent data Data available Policy in preparation No data Not available Below target Restrictions No data
Slovakia No recent data Data available No recent data Data available No policy No data Not available Below target Restrictions No data
Slovenia No recent data Data available No recent data No recent data Inclusive policy No data Available Below target No restriction No data
Spain Data available Data available No recent data Data available Inclusive policy Below target Available Below target No restriction No significant decrease
Sweden No recent data Data available Data available Data available Inclusive policy No data Available On target No restriction No data
Türkiye No recent data Data available No recent data Data available No data No data No data On target No data No significant decrease
On target (out of 29) 16 25 6 18 19 2 18 9 21 0

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Table 1. Estimated number of people who inject drugs and prevalence of injecting drug use, by country (source data for Figure 1)
Country Central estimate Central rate High estimate High rate Low estimate Low rate Method Year
FR 129703 3.2 133724 3.3 125681 3.1 CR 2019
CZ 40800 6.0 41500 6.0 40000 5.8 TM 2019
FI 15611 4.6 22665 6.7 13770 4.1 OT 2012
PT 13162 2.1 28497 4.5 6416 1.0 CR 2015
ES 10341 0.3 14365 0.5 6318 0.2 OT 2018
LT 8868 4.6 9364 4.9 8371 4.4 MIM 2016
EE 8606 10.0 9658 11.2 7736 9.0 CR 2015
NO 8269 2.4 9779 2.8 6946 2.0 MM 2018
LV 7715 6.1 8678 6.8 6751 5.3 TM 2016
BE 7018 0.8 9527 1.0 4794 0.5 CR 2019
HU 6707 1.0         CM 2015
HR 6344 2.2 8255 2.9 5147 1.8 MM 2015
GR 3287 0.5 4599 0.7 2466 0.4 CR 2019
NL 840 0.1 960 0.1 780 0.1 OT 2015
LU 800 1.9         CM 2018
CY 637 1.1 867 1.5 490 0.8 TP 2019

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Table 2. Prevalence of HCV antibodies among people who inject drugs, by country, 2019 or latest available data (source data for Figure 2)
Country Geographical coverage Location Study design Level of evidence Year Number tested Prevalence (%)
Austria Subnational Graz Routine diagnostic test Low 2019 67 83.6
Austria Subnational Vienna Routine diagnostic test Low 2019 182 86.8
Belgium Subnational Other seroprevalence study High 2019 168 41
Belgium Subnational Other Routine diagnostic test Moderate 2019 197 22
Bulgaria Subnational Sofia Routine diagnostic test Moderate 2019 383 78.3
Bulgaria Subnational Multi-city seroprevalence study Moderate 2016 359 68.5
Cyprus National National Routine diagnostic test High 2019 102 53.9
Cyprus National National seroprevalence study Low 2018 80 61.3
Czechia National National Routine diagnostic test High 2019 1557 20.2
Germany Subnational Frankfurt seroprevalence study Moderate 2013 285 64.6
Germany Subnational Hamburg seroprevalence study Moderate 2014 319 67.7
Germany Subnational Hannover seroprevalence study Moderate 2013 252 73
Germany Subnational Koln seroprevalence study Moderate 2013 322 66.5
Germany Subnational Munich seroprevalence study Moderate 2013 235 62.5
Estonia Subnational Narva seroprevalence study Moderate 2018 350 79.7
Estonia Subnational Tallin seroprevalence study Moderate 2017 112 89.3
Spain National National Routine diagnostic test High 2018 3695 58.9
Finland Subnational Multi-city seroprevalence study High 2014 589 74
Greece National National Routine diagnostic test High 2019 671 61.5
Greece Subnational Attica Routine diagnostic test High 2019 260 63.8
Greece Subnational Multi-region Routine diagnostic test High 2019 275 61.1
Greece Subnational Thessaloniki Routine diagnostic test High 2019 136 58.1
Croatia Subnational Multi-city seroprevalence study High 2014 817 38.3
Hungary National National seroprevalence study Moderate 2018 439 43.5
Hungary Subnational Budapest seroprevalence study Moderate 2018 218 42.7
Hungary Subnational Multi-city seroprevalence study Moderate 2018 221 44.3
Hungary Subnational Multi-city seroprevalence study Moderate 2019 102 48
Italy National National Routine diagnostic test High 2019 8832 61.5
Italy Subnational Emilia Romagna Routine diagnostic test High 2013 1489 57.9
Italy Subnational Lombardia Routine diagnostic test High 2013 405 54.1
Italy Subnational Umbria Routine diagnostic test Moderate 2013 62 71
Lithuania Subnational Multi-city seroprevalence study Moderate 2014 200 77
Lithuania National National seroprevalence study High 2018 369 85.9
Luxembourg National National Routine diagnostic test Moderate 2018 35 62.9
Latvia National Multi-city seroprevalence study Moderate 2017 386 85.2
Latvia National National Routine diagnostic test High 2019 666 47
Malta National National Routine diagnostic test High 2019 121 43.8
Norway Subnational Oslo seroprevalence study Moderate 2018 268 61.6
Norway National National seroprevalence study High 2018 5929 38.8
Poland National National seroprevalence study Moderate 2017 171 57.9
Poland Subnational Cracow seroprevalence study Moderate 2017 36 61.1
Poland Subnational Slaskie seroprevalence study Moderate 2017 50 38
Poland Subnational Warsaw seroprevalence study Moderate 2017 66 75.8
Portugal National National Routine diagnostic test High 2019 325 81
Romania Subnational Bucharest seroprevalence study Moderate 2017 444 79.3
Sweden Subnational Stockholm Routine diagnostic test Low 2012 65 95.4
Sweden Subnational Multi-city Routine diagnostic test Low 2013 62 96.8
Slovenia National National Routine diagnostic test Moderate 2019 39 15.4
Slovakia Subnational Bratislava seroprevalence study Low 2019 56 51.8
Türkiye National National seroprevalence study High 2018 2409 49.2
Türkiye National National seroprevalence study High 2019 2551 39.2

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Table 3. Prevalence (%) of current HCV infection (HCV RNA+) among people who inject drugs, by country, 2019 or latest available data (source data for Figure 3)
Country Geographical coverage Location Study design Level of evidence Year Number tested Prevalence (%)
Austria Subnational Graz Routine diagnostic test Low 2019 67 23.9
Austria Subnational Vienna Routine diagnostic test Low 2019 162 64.2
Belgium Subnational Other Routine diagnostic test Moderate 2019 211 15
Germany Subnational Frankfurt seroprevalence study Moderate 2013 285 50.2
Germany Subnational Hamburg seroprevalence study Moderate 2014 319 44.8
Germany Subnational Hannover seroprevalence study Moderate 2013 252 54
Germany Subnational Koln seroprevalence study Moderate 2013 322 47.5
Germany Subnational Munich seroprevalence study Moderate 2013 235 36.2
Greece National National Routine diagnostic test High 2019 115 53.9
Greece Subnational Attica Routine diagnostic test High 2019 74 56.8
Greece Subnational Multi-region Routine diagnostic test High 2019 31 51.6
Norway Subnational Oslo seroprevalence study Moderate 2018 267 25.8
Sweden Subnational Stockholm Routine diagnostic test Low 2014 1386 62.1

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Table 4. Prevalence (%) of current HBV infection (HBsAg+) among people who inject drugs, by country, 2019 or latest available data (source data for Figure 4)
Country Geographical coverage Location Study design Level of evidence Year Number tested Prevalance (%)
Austria Subnational Vienna Routine diagnostic test Low 2019 140 0.7
Belgium Subnational Antwerp Routine diagnostic test Low 2014 373 1.9
Bulgaria Subnational Sofia Routine diagnostic test Moderate 2019 374 5.9
Bulgaria Subnational Multi-city seroprevalence study Moderate 2016 359 8.6
Cyprus National National Routine diagnostic test High 2019 93 1.1
Cyprus National National seroprevalence study Low 2018 65 16.9
Germany Subnational Frankfurt seroprevalence study Moderate 2013 285 1.4
Germany Subnational Hamburg seroprevalence study Moderate 2014 319 0.6
Germany Subnational Hannover seroprevalence study Moderate 2013 252 0.4
Germany Subnational Koln seroprevalence study Moderate 2013 322 1.2
Germany Subnational Munich seroprevalence study Moderate 2013 235 0.9
Estonia Subnational Narva seroprevalence study Moderate 2018 350 5.7
Estonia Subnational Tallin seroprevalence study Moderate 2017 112 8
Spain National National Routine diagnostic test High 2018 1791 7.8
Greece National National Routine diagnostic test High 2019 681 3.2
Greece Subnational Attica Routine diagnostic test High 2019 268 1.9
Greece Subnational Multi-region Routine diagnostic test High 2019 280 3.6
Greece Subnational Thessaloniki Routine diagnostic test High 2019 133 5.3
Hungary National National seroprevalence study High 2015 596 2.2
Hungary Subnational Multi-city Routine diagnostic test Moderate 2013 223 2.2
Lithuania Subnational Multi-city seroprevalence study Moderate 2014 200 10.5
Lithuania National National seroprevalence study High 2018 286 4.9
Latvia National Multi-city seroprevalence study Moderate 2017 386 3.6
Latvia National National Routine diagnostic test High 2019 813 0
Norway Subnational Oslo seroprevalence study Moderate 2018 268 0.8
Poland National National seroprevalence study Moderate 2017 172 2.9
Poland Subnational Cracow seroprevalence study Moderate 2017 37 5.4
Poland Subnational Slaskie seroprevalence study Moderate 2017 50 2
Poland Subnational Warsaw seroprevalence study Moderate 2017 66 3
Portugal National National Routine diagnostic test High 2019 317 6
Romania Subnational Bucharest seroprevalence study Moderate 2017 444 8.7
Sweden Subnational Stockholm Routine diagnostic test Low 2014 1386 2.1
Slovakia Subnational Bratislava seroprevalence study Low 2019 50 0
Slovakia Subnational Bratislava Routine diagnostic test Moderate 2018 59 1.7
Türkiye National National seroprevalence study High 2018 2409 3.5
Türkiye National National seroprevalence study High 2019 2551 4.5

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Table 5. Countries with viral hepatitis policy inclusive of people who inject drugs, 2019 (source data for Figure 5)
Country Policy
Belgium Inclusive policy
Cyprus Inclusive policy
Denmark Inclusive policy
Finland Inclusive policy
France Inclusive policy
Germany Inclusive policy
Ireland Inclusive policy
Italy Inclusive policy
Latvia Inclusive policy
Malta Inclusive policy
Netherlands Inclusive policy
Norway Inclusive policy
Portugal Inclusive policy
Slovenia Inclusive policy
Spain Inclusive policy
Sweden Inclusive policy
Greece Inclusive policy
Luxembourg Inclusive policy
Austria Inclusive policy
Türkiye No data
Bulgaria No policy
Estonia No policy
Lithuania No policy
Slovakia No policy
Croatia Policy in preparation
Czechia Policy in preparation
Poland Policy in preparation
Romania Policy in preparation
Hungary Policy in preparation

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Table 6. Number of sterile syringes distributed per person who injects drugs and proportion of high-risk opioid users in opioid substitution treatment (OST), by country, 2019 or latest available data (source data for Figure 6)
Country People who inject drugs, year of estimate Number people who inject drugs High-risk opioid use, year of estimate Number high-risk opioid users Total number of syringes distributed Total number of OST clients Proportion in OST Syringes per person who injects drugs
Croatia 2015 6344 2015 8874 234487 5061 0.57 37
Cyprus 2019 637 2019 1022 878 277 0.27 1
Czechia 2019 40800 2019 10500 7459123 5000 0.48 183
Finland 2017 25000 2017 26200 5800000 3329 0.13 232
France 2019 129703 2019 202485 12840577 177100 0.87 99
Greece 2019 3287 2019 14753 464745 9708 0.66 141
Hungary 2015 6707 2010-11 3244 188696 715 0.22 28
Latvia 2016 7715 2017 7100 720494 669 0.09 93
Lithuania 2016 8868 2016 7503 240061 1231 0.16 27
Luxembourg 2018 800 2018 1470 492704 1117 0.76 616
Norway 2018 8269 2013 9015 3.00E+06 7055 0.78 363
Portugal 2015 13162 2018 28287 1004706 17246 0.61 76
Spain 2018 10341 2018 64983 1812069 58447 0.9 175
Belgium 2019 7018 NA NA NA NA 0.72 178

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Table 7. Availability of HBV vaccination targeting people who use drugs and are in prison, by country, 2019-2020 (source data for Figure 7)
Country Status
Austria Available
Belgium Available
Bulgaria No data
Croatia Not available
Cyprus No data
Czechia No data
Denmark Available
Estonia Available
Finland Available
France Available
Germany Available
Greece Available
Hungary Available
Ireland Available
Italy Available
Latvia Not available
Lithuania Not available
Luxembourg Available
Malta No data
Netherlands Not available
Norway Available
Poland Available
Portugal Available
Romania Not available
Slovakia Not available
Slovenia Available
Spain Available
Sweden Available
Türkiye No data

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Table 8. Percentage of people entering drug treatment reporting injecting drugs who had been tested for HCV in the previous 12 months, by country, 2019 or latest data available (source data for Figure 8)
Country Year Clients included Percentage tested Completeness (% of data with available information on tests)
Türkiye 2019 1282 81.4 88
Luxembourg 2019 110 80.9 96
Bulgaria 2019 246 73.9 57
Sweden 2019 174 68.5 94
Czechia 2019 656 61.7 62
Austria 2019 279 58.7 54
France 2019 189 55.9 10
Ireland 2019 460 53.4 73
Finland 2019 163 53.3 94
Cyprus 2019 61 49.6 88
Spain 2018 658 48 63
Slovenia 2019 26 47.3 96
Romania 2017 305 46.5 92
Germany 2019 668 39.4 100
Poland 2019 222 35.9 90
Slovakia 2019 206 34 72
Latvia 2017 46 24.6 60
Malta 2019 125 23.1 86
Denmark 2018 44 21.6 78
Portugal 2019 37 17.4 100
Italy 2019 1100 15.8 100

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Table 9. Existence of restrictive clinical or reimbursement guidelines on access to DAA by people who inject drugs, by country, 2019 (source data for Figure 9)
Country Restrictions
Bulgaria Clinical and financial restictions
Croatia Clinical and financial restictions
Cyprus Clinical and financial restictions
Poland Clinical and financial restictions
Romania Clinical and financial restictions
Slovakia Clinical and financial restictions
Estonia Clinical restrictions
Türkiye No data
Belgium No restriction
Czechia No restriction
Denmark No restriction
Finland No restriction
France No restriction
Germany No restriction
Ireland No restriction
Italy No restriction
Latvia No restriction
Lithuania No restriction
Malta No restriction
Netherlands No restriction
Norway No restriction
Portugal No restriction
Slovenia No restriction
Spain No restriction
Sweden No restriction
Greece No restriction
Hungary No restriction
Luxembourg No restriction
Austria No restriction

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Table 10. Trends in HCV antibody prevalence (%) among people who inject drugs aged less than 25 years: results from diagnostic tests and seroprevalence studies with national or multi-city coverage, 2013-2019 (source data for Figure 10)
Country Study ID Geographical coverage Year Numnber tested Prevalance (%) 95% Confidence interval Study design
Bulgaria BG0001 Sofia 2013 76 59.2 48.2% - 70.2% Routine diagnostic test
Bulgaria BG0001 Sofia 2014 50 38 24.5% - 51.5% Routine diagnostic test
Bulgaria BG0001 Sofia 2015 86 52.3 41.7% - 62.9% Routine diagnostic test
Bulgaria BG0001 Sofia 2016 57 50.9 37.9% - 63.9% Routine diagnostic test
Czechia CZ0007 National 2013 418 9.1 6.3% - 11.9% Routine diagnostic test
Czechia CZ0007 National 2014 318 11.9 8.3% - 15.5% Routine diagnostic test
Czechia CZ0007 National 2015 171 14 8.8% - 19.2% Routine diagnostic test
Czechia CZ0007 National 2016 298 11.7 8.1% - 15.3% Routine diagnostic test
Czechia CZ0007 National 2017 294 11.6 7.9% - 15.3% Routine diagnostic test
Czechia CZ0007 National 2018 218 11.9 7.6% - 16.2% Routine diagnostic test
Czechia CZ0007 National 2019 231 13.4 9% - 17.8% Routine diagnostic test
Spain ES0001 National 2014 50 12 3% - 21% Routine diagnostic test
Spain ES0001 National 2015 39 20.5 7.8% - 33.2% Routine diagnostic test
Spain ES0001 National 2016 62 17.7 8.2% - 27.2% Routine diagnostic test
Spain ES0001 National 2017 37 13.5 2.5% - 24.5% Routine diagnostic test
Spain ES0001 National 2018 38 13.2 2.4% - 24% Routine diagnostic test
Greece GR0014 National 2013 80 58.8 48% - 69.6% Routine diagnostic test
Greece GR0014 National 2014 79 50.6 39.6% - 61.6% Routine diagnostic test
Greece GR0014 National 2015 69 56.5 44.8% - 68.2% Routine diagnostic test
Greece GR0014 National 2016 48 47.9 33.8% - 62% Routine diagnostic test
Greece GR0014 National 2017 43 67.4 53.4% - 81.4% Routine diagnostic test
Greece GR0014 National 2018 38 50 34.1% - 65.9% Routine diagnostic test
Greece GR0014 National 2019 37 32.4 17.3% - 47.5% Routine diagnostic test
Italy IT0001 National 2013 466 34.5 30.2% - 38.8% Routine diagnostic test
Italy IT0001 National 2014 439 28 23.8% - 32.2% Routine diagnostic test
Italy IT0001 National 2015 334 28.7 23.8% - 33.6% Routine diagnostic test
Italy IT0001 National 2016 285 29.5 24.2% - 34.8% Routine diagnostic test
Italy IT0001 National 2017 267 33.7 28% - 39.4% Routine diagnostic test
Italy IT0001 National 2018 331 26.6 21.8% - 31.4% Routine diagnostic test
Italy IT0001 National 2019 250 22.4 17.2% - 27.6% Routine diagnostic test
Latvia LV0010 National 2013 84 41.7 31.2% - 52.2% Routine diagnostic test
Latvia LV0010 National 2015 115 16.5 9.7% - 23.3% Routine diagnostic test
Latvia LV0010 National 2016 110 24.5 16.5% - 32.5% Routine diagnostic test
Latvia LV0010 National 2017 97 24.7 16.1% - 33.3% Routine diagnostic test
Latvia LV0010 National 2019 68 26.5 16% - 37% Routine diagnostic test
Türkiye TR0001 National 2013 1101 41.4 38.5% - 44.3% Sero-prevalence study
Türkiye TR0001 National 2014 1371 36.5 34% - 39% Sero-prevalence study
Türkiye TR0001 National 2015 1173 30.1 27.5% - 32.7% Sero-prevalence study
Türkiye TR0001 National 2017 824 36.8 33.5% - 40.1% Sero-prevalence study
Türkiye TR0001 National 2018 798 40.9 37.5% - 44.3% Sero-prevalence study

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Table 11. Trends in HCV antibody prevalence (%) among people injecting drugs for less than 2 years: results from diagnostic tests and seroprevalence studies with national or multi-city coverage, 2013-2019 (source data for Figure 11)
Country Study ID Geographical coverage Year Number tested Prevalence (%) 95% Confidence interval (CI) Study design
Czechia CZ0007 National 2013 120 9.2 4% - 14.4% Routine diagnostic test
Czechia CZ0007 National 2014 88 8 2.3% - 13.7% Routine diagnostic test
Czechia CZ0007 National 2015 59 8.5 1.4% - 15.6% Routine diagnostic test
Czechia CZ0007 National 2016 96 8.3 2.8% - 13.8% Routine diagnostic test
Czechia CZ0007 National 2017 148 11.5 6.4% - 16.6% Routine diagnostic test
Czechia CZ0007 National 2018 109 9.2 3.8% - 14.6% Routine diagnostic test
Czechia CZ0007 National 2019 89 15.7 8.1% - 23.3% Routine diagnostic test
Spain ES0001 National 2014 26 42.3 23.3% - 61.3% Routine diagnostic test
Spain ES0001 National 2015 48 29.2 16.3% - 42.1% Routine diagnostic test
Spain ES0001 National 2016 61 27.9 16.6% - 39.2% Routine diagnostic test
Spain ES0001 National 2017 48 33.3 20% - 46.6% Routine diagnostic test
Spain ES0001 National 2018 69 29 18.3% - 39.7% Routine diagnostic test
Greece GR0014 Multi-region 2013 77 63.6 52.9% - 74.3% Routine diagnostic test
Greece GR0014 Multi-region 2014 31 38.7 21.6% - 55.8% Routine diagnostic test
Greece GR0014 Multi-region 2015 41 36.6 21.9% - 51.3% Routine diagnostic test
Greece GR0014 Multi-region 2016 29 41.4 23.5% - 59.3% Routine diagnostic test
Greece GR0014 National 2013 244 76.6 71.3% - 81.9% Routine diagnostic test
Greece GR0014 National 2014 90 48.9 38.6% - 59.2% Routine diagnostic test
Greece GR0014 National 2015 73 34.2 23.3% - 45.1% Routine diagnostic test
Greece GR0014 National 2016 65 35.4 23.8% - 47% Routine diagnostic test
Greece GR0014 National 2017 51 43.1 29.5% - 56.7% Routine diagnostic test
Greece GR0014 National 2018 48 27.1 14.5% - 39.7% Routine diagnostic test
Greece GR0014 National 2019 45 33.3 19.5% - 47.1% Routine diagnostic test
Türkiye TR0001 National 2013 187 27.8 21.4% - 34.2% Sero-prevalence study
Türkiye TR0001 National 2014 885 21.1 18.4% - 23.8% Sero-prevalence study
Türkiye TR0001 National 2015 222 24.3 18.7% - 29.9% Sero-prevalence study
Türkiye TR0001 National 2017 78 29.5 19.4% - 39.6% Sero-prevalence study
Türkiye TR0001 National 2018 112 29.5 21.1% - 37.9% Sero-prevalence study

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Table 12. Trends in HCV RNA prevalence (%) among people who inject drugs: results from diagnostic tests and seroprevalence studies with national or multi-city coverage,2013-2019 (source data for Figure 12)
Country Study ID Geographical coverage Year Number tested Prevalence (%) 95% Confidence interval (CI) Study design Level of evidence
Austria AT0001 Graz 2013 85 43.5 33% - 54% Routine diagnostic test Low
Austria AT0001 Graz 2014 82 43.9 33.2% - 54.6% Routine diagnostic test Low
Austria AT0001 Graz 2015 69 44.9 33.2% - 56.6% Routine diagnostic test Low
Austria AT0001 Graz 2016 81 27.2 17.5% - 36.9% Routine diagnostic test Low
Austria AT0001 Graz 2017 68 35.3 23.9% - 46.7% Routine diagnostic test Low
Austria AT0001 Graz 2018 68 45.6 33.8% - 57.4% Routine diagnostic test Low
Austria AT0001 Graz 2019 67 23.9 13.7% - 34.1% Routine diagnostic test Low
Austria AT0003 Vienna 2013 124 58.1 49.4% - 66.8% Routine diagnostic test Low
Austria AT0003 Vienna 2014 132 64.4 56.2% - 72.6% Routine diagnostic test Low
Austria AT0003 Vienna 2015 166 65.7 58.5% - 72.9% Routine diagnostic test Low
Austria AT0003 Vienna 2016 203 71.4 65.2% - 77.6% Routine diagnostic test Low
Austria AT0003 Vienna 2017 269 65.1 59.4% - 70.8% Routine diagnostic test Low
Austria AT0003 Vienna 2018 161 66.5 59.2% - 73.8% Routine diagnostic test Low
Austria AT0003 Vienna 2019 162 64.2 56.8% - 71.6% Routine diagnostic test Low
Greece GR0004 Attica 2013 139 36.7 28.7% - 44.7% Sero-prevalence study Moderate
Greece GR0004 Attica 2014 60 48.3 35.7% - 60.9% Sero-prevalence study Low
Greece GR0004 Attica 2015 61 31.1 19.5% - 42.7% Sero-prevalence study Low
Greece GR0014 Attica 2016 89 50.6 40.2% - 61% Routine diagnostic test High
Greece GR0014 Attica 2017 100 51 41.2% - 60.8% Routine diagnostic test High
Greece GR0014 Attica 2019 74 56.8 45.5% - 68.1% Routine diagnostic test High
Greece GR0014 National 2016 128 50.8 42.1% - 59.5% Routine diagnostic test High
Greece GR0014 National 2017 101 50.5 40.7% - 60.3% Routine diagnostic test High
Greece GR0014 National 2019 115 53.9 44.8% - 63% Routine diagnostic test High
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