The EU Joint Action on HIV and Co-infection Prevention and Harm Reduction, more easily known as “HA-REACT”, is a comprehensive project that contributes to the elimination of HIV and reduction of TB and viral hepatitis among people who inject drugs (PWID) in the European Union by 2020. The project was launched in December 2015 and over the past year partners have been in the process of scaling up their work in improving HIV and HCV testing among people who inject drugs, scaling up harm reduction services both in prison and civil settings, improving linkage to care, and ensuring sustainability and long-term funding for harm reduction.

Navigating separate addiction, mental health, HIV, hepatitis, TB, and social support services is a task that only a small minority of PWID can achieve.

23 partners from 18 member states are collaborating on these principal themes particularly focused on EU member states where obvious gaps in effective interventions exist and encourage all EU states to implement harm reduction programs as an essential strategy for improving the prevention and treatment of HIV, TB, and viral hepatitis among PWID. Five of the work packages are used to delineate areas of focus on specific gaps and priority topics.

After one year of working together, crucial gaps in service pathways for PWID are becoming visible in the countries where we work. For example; testing with a low threshold is available in many countries. However pathways to care are fragmented and almost impossible to access for many vulnerable groups. Navigating separate harm reduction, mental health, HIV, hepatitis, TB, and social support services is a task that only a small minority of PWID can achieve. This needs to change and services need to be integrated in practice, not only in spirit. HA-REACT is working toward this goal.

Harm reduction is a vital part of the HA-REACT joint action as it is systematically overlooked and underfunded in many EU member states.

The “testing and linkage to care for people who use drugs” work focuses on Hungary and Latvia and is led by Deutsche AIDS-Hilfe in Germany. During the first year they have been focusing on producing client-centered leaflets and posters for PWID in order to promote rapid HIV and HCV tests. These materials are prepared primarily for low threshold facilities in in the two countries and are available in English, Hungarian, Latvian, and Russian here.

Harm reduction is a vital part of the HA-REACT joint action as it is systematically overlooked and underfunded in many EU member states. As part of “scaling up harm reduction” a general analysis, summary of involvement of main actors in each of the focus countries, and development of targeted activities to improve the prevention of HIV, viral hepatitis, and TB in PWID is spearheaded by the Center for Biomedical Research Network (CIBER/ISCIII) in Spain.

Study visits have been carried out, both in the focus countries and in Spain to learn about harm reduction in other settings, as well as seminars in both focus countries (Latvia and Lithuania). And to make a difference on the ground, a harm reduction mobile unit was approved in Latvia and the necessary material for the unit has been purchased.

On harm reduction in European prisons, HA-REACT has introduced an e-learning platform with 4 courses designed as self-study online courses. These are:

• Condom distribution programs in prisons
• Prison needle and syringe programs (PNSP)
• Harm reduction in prisons
• Opioid substitution treatment (OST).

Integrated HIV, viral hepatitis, TB care, and harm reduction for PWID is essential if we want to succeed in curbing these epidemics in Europe.

Sustainability and funding in harm reduction is a critical part of all harm reduction programs. A systematic review of literature is additionally taking place on barriers to accessing health services and harm reduction services for PWID, as well as a policy review of harm reduction in three focus countries (Hungary, Latvia, and Lithuania), and a survey for non-governmental harm reduction service providers across the EU will be distributed soon. Collaboration on these topics with organizations on our Advisory Board such as the Correlation Network and the Eurasian Harm Reduction Network (EHRN) is also key.

Integrated HIV, viral hepatitis, TB care, and harm reduction for PWID is essential if we want to succeed in curbing these epidemics in Europe. The integrated care for PWID work package, led by the National Institute for Health Development (TAI/NIHD) in Estonia, aims to improve care across the participating countries by bringing together professionals from different sectors to exchange good practices and develop practical tools on the implementation of care models.

This World AIDS Day is about #HIVPrevention – and so is our Joint Action. We look forward to sharing further results with you in 2017.

The Joint Action aims to contribute to the elimination of HIV and reduction of TB and viral hepatitis among PWID in the EU by 2020 and focuses on member states with gaps in effective and evidence-informed interventions. The project also encourages the implementation of comprehensive harm reduction programs in all EU member states as an essential strategy for improving the prevention and treatment of HIV, TB and viral hepatitis. Further information about HA-REACT is available at: https://www.hareact.eu/en

Hepatology, Medicine and Policy is now accepting submissions on this and related issues. For more information, visit: www.hmap.biomedcentral.com.