Correction: Monitoring progress towards elimination of hepatitis B and C in the EU/EEA.

[This corrects the article DOI: 10.1371/journal.pgph.0000841.].

Different phases of ATS use call for different interventions: a large qualitative study in Europe.

BACKGROUND: Amphetamine-type stimulants (ATS) are globally widely used. Scientific literature generally defines four phases of substance use (initiation, continuation, increase and decrease); however, there is limited understanding of what influences these different phases of ATS use. The ATTUNE study investigated which factors shape individual phases of use, or ATS use patterns. In this article, we report on these phases into and out of ATS use, and propose a set of recommendations for prevention, harm reduction and treatment of the different phases of ATS use. METHODS: Qualitative, semi-structured interviews (n = 237) were conducted in five different European countries with participants who had used ATS, varying from a few times in a lifetime to daily. RESULTS: Amphetamine and MDMA were the most commonly used ATS. Yet, types of ATS used differed between the countries. We found that people who use ATS have various motives for and dynamic patterns of ATS use with alternating phases of increase, continuation, decrease and sometimes dependence. Cessation was pursued in different ways and for diverse reasons, such as mental health problems and maturing out. Availability seemed not an issue, regardless of the type of ATS, phase or country. CONCLUSIONS: These findings demonstrate that tailor-made interventions are needed for the diverse types of people who use ATS and different phases or patterns of ATS use, to reduce possible harms of use. We recommended a set of interventions for the different ATS phases. These include drug checking services, peer-led information, self-management of ATS use, mental health support to help people cope with stressful life events and prevent uncontrolled use, and follow-up support after treatment.

Monitoring progress towards elimination of hepatitis B and C in the EU/EEA.

This paper presents data on selected indicators to show progress towards elimination goals and targets for hepatitis B and hepatitis C in the 31 countries of the European Union (EU) and European Economic Area (EEA). A monitoring system was developed by the European Centre for Disease Prevention and Control, which combined newly collected data from EU/EEA countries along with relevant data from existing sources. Data for 2017 were collected from the EU/EEA countries via an online survey. All countries provided responses. In 2017, most countries reporting data had not reached prevention targets for childhood hepatitis B vaccination and for harm reduction services targeting people who inject drugs (PWID). Four of 12 countries had met the target for proportion of people living with chronic HBV diagnosed and seven of 16 met this target for hepatitis C. Data on diagnosed cases treated were lacking for hepatitis B. Of 12 countries reporting treatment data for hepatitis B, only Iceland met the target. This first collection of data across the EU/EEA highlighted major issues with data completeness and quality and in the indicators that were used, which impairs a clear overview of progress towards the elimination of hepatitis. The available data, whilst incomplete, suggest that as of 2017, the majority of the EU/EEA countries were far from meeting most of the 2020 targets, in particular those relating to harm reduction and diagnosis. It is critical to improve the data collected in order to develop more effective services for hepatitis prevention, diagnosis, and treatment that are needed in order to meet the 2030 elimination targets.

Harm reduction in Europe: a framework for civil society-led monitoring.

BACKGROUND: Civil society organisations (CSOs) play a vital role in developing and implementing effective measures to reduce the harms of drug use. They are also fundamental actors to monitor and evaluate programmes and policies for improvement. While harm reduction services are subject to monitoring, and international and European indicators exist, a framework for civil society-led monitoring does not exist. This paper analyses the challenges and added values of developing such a framework for the European region. METHODS: Since 2018, a technical working group within Correlation-European Harm Reduction Network (C-EHRN) is developing and revising a monitoring framework, collecting-through National Focal Points-the experience of harm reduction service providers and service users in 34 European countries. The first round of data collection, in 2019, focused on hepatitis C, overdose prevention, new drug trends and civil society involvement in drug policies. RESULTS: Developing CSO-based harm reduction monitoring is a learning by doing process. Assuring reliability and national representativeness of the data was a central challenge. As most CSOs have little or no experience with monitoring and research and work in a local-based context, the monitoring approach and its indicators were adjusted to the local context in the second round, bringing more in-depth information and helping to improve results' reliability. While this implied shifting from the initial focus on comparing responses at a national level, the change to collecting qualitative data reflecting local realities of service policies and delivery provides the foundations for a critical appraisal of these realities against European policy goals. This allowed to map discrepancies between official policies and their implementation, as well as identify gaps in and complement data collection from national-level agencies. CONCLUSIONS: By focusing on local experiences regarding the delivery of global and European policy targets, C-EHRN monitoring uses the unique strengths of its CSOs network and generates information that complements the reporting by other monitoring agencies. Data reflecting the CSOs perspective is essential for optimising local planning of service provision and development of effective and respectful drug policies at national and European level. If data quality issues, as well as the sustainability of reporting, are adequately addressed, civil society monitoring can provide excellent added value for the monitoring of harm reduction in Europe.

From opiates to methamphetamine: building new harm reduction responses in Jakarta, Indonesia.

BACKGROUND: Despite the rise of stimulant use, most harm reduction programs still focus on people who inject opioids, leaving many people who use methamphetamine (PWUM) underserviced. In Asia, especially, where methamphetamine prevalence has overtaken opioids prevalence, harm reduction programs assisting PWUM are rare. The few existing innovative practices focusing on methamphetamine use lie underreported. Understanding how these programs moved their focus from opiates to methamphetamine could help inspire new harm reduction responses. Hence, this paper analyzes a newly implemented outreach program assisting methamphetamine users in Jakarta, Indonesia. It addresses the program's critical learning points when making the transition to respond to stimulant use. METHODS: This case study is part of a more extensive research on good practices of harm reduction for stimulant use. For this case study, data was collected through Indonesian contextual documents and documents from the program, structured questionnaire, in-depth interviews with service staff and service users, a focus group discussion with service users, and in-loco observations of activities. For this paper, data was reinterpreted to focus on the key topics that needed to be addressed when the program transitioned from working with people who use opioids to PWUM. RESULTS: Four key topics were found: (1) getting in touch with different types of PWUM and building trust relationships; (2) adapting safer smoking kits to local circumstances; (3) reframing partnerships while finding ways to address mental health issues; and (4) responding to local law enforcement practices. CONCLUSIONS: The meaningful involvement of PWUM was essential in the development and evaluation of outreach work, the planning, and the adaptation of safer smoking kits to local circumstances. Also, it helped to gain understanding of the broader needs of PWUM, including mental health care and their difficulties related to law enforcement activities. Operating under a broad harm reduction definition and addressing a broad spectrum of individual and social needs are preferable to focusing solely on specific interventions and supplies for safer drug use. Since many PWUM smoke rather than inject, securing funding for harm reduction focused on people who do not inject drugs and/or who do not use opioids is fundamental in keeping programs sustainable.

[Mapping harm reduction programs in Greater Metropolitan Porto Alegre, Rio Grande do Sul State, Brazil]. / Mapeando programas de redução de danos da Região Metropolitana de Porto Alegre, Rio Grande do Sul, Brasil.

This study mapped and described 11 harm reduction interventions/programs in Greater Metropolitan Porto Alegre, Rio Grande do Sul State, Brazil, in 2004-2006. Mapping was based on interviews and analysis of available documents and comparison with a previous study with data from 2003. We aimed to discuss the programs' sustainability (political, financial, and administrative) and operational characteristics, based on the following categories: type of links in the program or intervention; forms of inclusion in the municipalities; background, financing; typical activities; team hiring practices; volunteer work, if any; resources (human and financial); partnerships; municipal legislation, if any; and participation in forums for political representation. Despite the diversity of links and organizational formats, there were some common characteristics: precarious professional status; dependence on volunteer work to implement activities; influence of turnover in Municipal and State administration on the continuity of projects and partnerships, as well as on the maintenance of human and financial resources. We conclude that such factors lead to lack of continuity in the services provided to the target population.

Mapeando programas de redução de danos da Região Metropolitana de Porto Alegre, Rio Grande do Sul, Brasil / Mapping harm reduction programs in Greater Metropolitan Porto Alegre, Rio Grande do Sul State, Brazil

Neste estudo mapeamos e descrevemos 11 programas/ações em redução de danos vigentes nos anos de 2004 a 2006, na Região Metropolitana de Porto Alegre, Rio Grande do Sul, Brasil. A descrição e análise se construíram por meio de entrevistas com as coordenações dos programas, de análise documental e da comparação com um mapeamento realizado em 2003. Buscou-se discutir a sustentabilidade (política, financeira e administrativa) e as características de funcionamento dos programas. A análise utilizou as seguintes categorias: tipo de vínculo do programa/ação; formas de inserção nos municípios; histórico, financiamento; ações típicas; forma de contratação da equipe; existência de trabalho voluntário; recursos (humanos e financeiros); parcerias; existência de legislação municipal; e participação em espaços de representação política. Apesar da diversidade de vínculos e formas de organização dos locais analisados, algumas características são comuns, como: inserção profissional precária; dependência do trabalho voluntário para a execução das atividades; influência das mudanças de gestão municipal e estadual para a continuidade de projetos e de parcerias, assim como para a manutenção de recursos humanos e financeiros dos programas. Concluímos que estes elementos geram descontinuidade no atendimento à população.

This study mapped and described 11 harm reduction interventions/programs in Greater Metropolitan Porto Alegre, Rio Grande do Sul State, Brazil, in 2004-2006. Mapping was based on interviews and analysis of available documents and comparison with a previous study with data from 2003. We aimed to discuss the programs' sustainability (political, financial, and administrative) and operational characteristics, based on the following categories: type of links in the program or intervention; forms of inclusion in the municipalities; background, financing; typical activities; team hiring practices; volunteer work, if any; resources (human and financial); partnerships; municipal legislation, if any; and participation in forums for political representation. Despite the diversity of links and organizational formats, there were some common characteristics: precarious professional status; dependence on volunteer work to implement activities; influence of turnover in Municipal and State administration on the continuity of projects and partnerships, as well as on the maintenance of human and financial resources. We conclude that such factors lead to lack of continuity in the services provided to the target population.

Marginalidade ou cidadania? A rede discursiva que configura o trabalho dos redutores de danos / Marginality or citzenship? The discursive net that configures the work of outreach workers

A revisão bibliográfica mostra que os estudos relativos à redução de danos (RD) se centram, predominantemente, na discussão das implicações de diferentes modelos de tratamento para o usuário de drogas e na redução de danos aplicada a usuários de drogas injetáveis. Porém, poucos estudos são encontrados acerca do trabalhador em RD. Neste contexto, o presente artigo propõe uma reflexão a respeito do trabalho dos redutores de danos, questionando como as formações discursivas sobre aids e drogas, na sociedade contemporânea, atravessam a subjetividade e o trabalho dos redutores, bem como sobre as possibilidades de inserção e sustentabilidade das ações em redução de danos (AU)

Marginalidade ou cidadania? a rede discursiva que configura o trabalho dos redutores de danos / Marginality or citzenship? the discursive net that configures the work of outreach workers

A revisão bibliográfica mostra que os estudos relativos à redução de danos (RD) se centram, predominantemente, na discussão das implicações de diferentes modelos de tratamento para o usuário de drogas e na redução de danos aplicada a usuários de drogas injetáveis. Porém, poucos estudos são encontrados acerca do trabalhador em RD. Neste contexto, o presente artigo propõe uma reflexão a respeito do trabalho dos redutores de danos, questionando como as formações discursivas sobre aids e drogas, na sociedade contemporânea, atravessam a subjetividade e o trabalho dos redutores, bem como sobre as possibilidades de inserção e sustentabilidade das ações em redução de danos.