The Netherlands Drug Situation 2010 - Trimbos-instituut

The expert group also discussed the issue of the “isolated” anti-HBc. In the campaign,presence of anti-HBc is interpreted as evidence of a hepatitis B infection in the past.These individuals are further tested for presence of HBsAg, to exclude active hepatitisB infection, and don’t receive further vaccinations, as immunity is assumed. A reanalysisof 1000 anti-HBc positive blood samples from the vaccination programshowed that 14.7% of confirmed anti-HBc lacked anti-HBs, indicating that these individualsare said to be immune but actually don’t have additional evidence of immunity(Koene et al., 2009). The prevalence of isolated anti-HBc was significantly higheramong drug users (51/228; 22.4%) than among the other risk groups (MSM: 6.3%,commercial sex workers 15.8%). After correction by other indicators for hepatitis B inserum and extrapolation it turned out that 12.5% of drug users lacked evidence ofimmunity. The expert group advised to expand the screening for drug users, both tocontinue finding hepatitis B carriers, but also to incorporate hepatitis C and HIVscreening during the intake procedure in addiction care. The advice to expand currentpractice of infectious disease screening has been offered to the minister of health.7.2.4 Hepatitis C information campaignFrom May 2009, the national information campaign for risk groups was developed andexecuted from September 2009 to February 2010. The campaign aimed to increaseknowledge on HCV among the general public, and to raise awareness and increase informationseeking behaviour among risk groups. The second aim was to enhance awarenessamong professionals in the field. Secondary objectives were to increase the number ofdiagnosed HCV cases and to structurally embed the attention for HCV in protocols anddaily practice. As risk groups in this campaign were considered: recipients of blood productsbefore 1992, drug users and migrants from high endemic countries. For the threerisk groups different campaign strategies were developed, which were first tested in apilot phase. The campaign used among others mass-media activities, an online hepatitisC risk assessment test (www.hebikhepatitis.nl), and flyers.The target group ‘drug users’ was defined as all drug users, especially injecting drugusers, even if only occasionally, and other drug users borrowing paraphernalia. All elevenaddiction care institutions in the Netherlands participated. Professionals (nurses, doctors)received a training for hepatitis C counselling; counselling talks were actively offered tothe target group; the drug users also received information materials; grass root organisationMainline supported the addiction care institutions with field work, among others byusing a game named “Russian Roulette”.All participating institutions drafted an implementation plan during the preparationphase. However, at the start of the campaign, in September 2009, only four were readyto start; some institutions started only in summer 2010 (officially after the campaign hadended), but all have the intention to continue with counselling and testing for HCV. Thecampaign was executed in a limited number of locations, some restricted the campaignto methadone posts, others also executed the campaign in drug consumption rooms,medical heroin units, prostitute zones, reception centres, or in labour-yards. In total 173professionals were trained in counselling; they had a counselling talk with almost 1300drug users, of whom just over half were tested for HCV; 25% was found positive and ofthese, one third (62 persons) started treatment. Note that the number of registeredopiate clients is over 12,000. The results are preliminary (personal communication Claryvan der Veen, Trimbos Institute).The level of implementation of the campaign differed substantially between institutions,but on average the implementation has not been optimal. A study on the promoting and104