Overcoming Barriers - Impact Story
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Overcoming Barriers

Mejorar la atención de la hepatitis C para personas que consumen drogas en las Islas Baleares, España

Photo: Red Cross

The Hepatitis C Free Balears project has transformed hepatitis C (HCV) care for people who use drugs in the Balearic Islands. Over two years (2021-2023), the project screened 1,423 people. Of these, 32% tested positive for HCV antibodies, and 12% had an active infection. By focusing on comprehensive care, the project achieved an impressive 95% cure rate among those treated. Collaboration between addiction service centres and hospitals was key to this success, improving communication and care delivery. The project also trained healthcare professionals and decentralised services, making it easier for patients to start - and stay - on treatment. This patient-centred approach underscores the importance of accessible healthcare for vulnerable populations and provides a successful model for HCV elimination. 

What is the problem?

HCV is a highly infectious disease that affects around 50 million people worldwide. In the Balearic Islands, Spain, approximately 1,350 people out of a population of 1.13 million remain untreated, with a significant portion being people who use drugs. In order to meet the WHO's goal of eliminating HCV by 2030, a targeted strategy for this high-risk group was urgently needed.

Key facts

2021 The two-year project Hepatitis C Free Balears was launched
1,423 people were screened for Hepatitis C Virus (HCV)
95% of those treated achieved a sustained virologic response (cure)
82% of people living with HIV who had discontinued treatment were reconnected to care

What did our researchers do?

The Hepatitis C Free Balears project (2021-2023), funded by the Gilead Sciences HCV-STAT programme, aimed to eliminate HCV in the Balearic Islands by targeting high-risk groups. The project focused on reaching patients with a history of drug use attended in 28 governmental and non-governmental addiction service centres (UCAs), NGO centres (Projecte Home), social inclusion centres, a mobile methadone unit, or in prison. The goal was to test these individuals and link them to HCV treatment and care. Key actions included:

  • Targeted interventions: 31 targeted interventions were carried out across UCAs, NGO centres, mobile methadone units, and social inclusion centres, with strategies adapted to the needs of each site;
  • Rapid testing: On-site rapid saliva tests provided results in 20 minutes, followed by confirmatory blood tests if needed;
  • Stakeholder engagement: Collaboration between addiction service centres, hospitals, and other key stakeholders streamlined communication and ensured seamless care delivery;
  • Personalised treatment and dispensing: HCV treatment was delivered based on the participants’ location. Medication dispensing was coordinated with participants’ existing appointments, such as those for HIV treatment or opioid substitution therapy, contributing to a patient-centred approach;
  • Training and workshops: Healthcare professionals were trained in HCV care, and workshops were held for people who use drugs to educate them about the disease and its treatment.

The project actively involved six public hospitals, one mobile methadone unit, one NGO (Projecte Home) with three main centres (one per island) and four satellite centres, 12 UCAs across the islands, four social inclusion centres, and four prisons in Mallorca.

This collaborative effort was led by ISGlobal’s Health Systems Research Group in collaboration with the Hospital Universitari Son Llàtzer (Mallorca), Hospital Universitari Son Espases (Mallorca), Hospital Comarcal d’Inca (Mallorca), Hospital Comarcal de Manacor (Mallorca), Hospital General Mateu Orfila (Menorca), Hospital Can Misses (Ibiza), Hospital Vall d’Hebron (Barcelona).

What changes has our research contributed to?

Easier access to HCV testing and treatment 

The project provided people who use drugs with quick access to diagnostic tests for HCV, hepatitis B virus (HBV), and HIV. By providing on-site testing, it eliminated the need for hospital visits, significantly reducing delays in treatment initiation. This approach resulted in a 95% sustained virologic response (cure) rate among those treated.

Although the UCAs treat the same population and offer the same services, they previously operated with different coordinators, resources, protocols and workflows. The project enabled the UCAs of IBSalut and those of the Consell de Mallorca to establish a common action protocol for HCV treatment across the UCAs of IBSalut and the Consell de Mallorca. This protocol recommends that all new admissions undergo an HCV, HIV and HBV test and includes an action plan for those with a known HCV diagnosis or with high-risk practices.

The Hepatitis C Free Balears project garnered attention from the scientific community, with the European Association for the Study of the Liver (EASL) highlighting it as “Read of the Week” on 14 October 2024. 

Improved personalisation of care for people who use drugs

Tailoring treatment according to individual needs and ensuring a flexible delivery of medication at the various locations resulted in higher adherence rates, with 84% of treatments completed.

Dr Antonella Perrotta of Projecte Home Mallorca commended the project for its innovative approach and alignment with the population’s needs, stating: '[The project] has been tailored to the particular needs of the people we serve. It is undoubtedly a step forward in guaranteeing the right to medical care and the right to health.’

Reconnecting people to HIV care

The project also had an impact on HIV treatment: 82% of the people living with HIV who had discontinued their treatment, were reconnected to care, by providing easy access to specialist services and reduced waiting times. This was regardless of whether they were also infected with HCV or not. In 35% of cases, HIV treatment was also delivered to the addiction service centres, which greatly enhanced treatment adherence.

Dr. Ana Agius, a physician at UCA Ponent, highlighted the transformative impact of the Hepatitis C Free Balears project on patient care and treatment accessibility. 

'The project has been exceptionally effective, particularly in overcoming the complex barriers our patients often face, which have historically hindered treatment adherence. The project effectively removed key obstacles that typically prevent our patients from receiving timely treatment. As a result, numerous patients, who had previously been lost in the system, finally received the treatment they needed, setting a new standard for care in our community.’

Increased training and awareness among staff

The project team organised a training day on the elimination of HCV in people who use drugs, targeting staff from addiction service centres and hospitals (September-October 2021). In addition, practical training sessions were held for hospital staff, including those in gastroenterology, pharmacy and microbiology departments. As a result, the project raised awareness about HCV among staff from 35 centres, including UCAs, NGOs, a mobile methadone unit, prisons and hospitals. 

As a result, several addiction service centres have been accredited as "Hepcelentes" for their efforts to eliminate HCV, highlighting the project's success in raising awareness and improving healthcare practices. 

Links and references