Ukraine: viral hepatitis and harm reduction services for refugees

The European Association for the Study of the Liver (EASL), the World Health Organization (WHO) and the European Centre for Disease Prevention and Control have issued a joint statement on viral hepatitis care for refugees from Ukraine.

Refugees from Ukraine have been granted temporary protection, including access to health care in European Union countries and other countries in the WHO Europe region.

The statement highlights the need for viral hepatitis care in refugee populations.

The rate of hepatitis B birth vaccination is lower in Ukraine than most European Union countries – only 80% of infants had received their third dose in 2020. Adult prevalence of hepatitis B is around 1% and adult hepatitis C prevalence is 3%. Prevalence of both viruses is higher in men and older age groups. Prevalence in people who inject drugs is especially high (HBsAg 8%, hepatitis C antibody 56% in 2020).

The statement recommends:

• When settled in the host country, testing for hepatitis B and hepatitis C should be voluntary and offered to all adult refugees in a non-discriminatory manner
• Hepatitis B vaccination should be offered for children and adolescents with unknown vaccination status or known delayed or missing vaccines, and others with risk factors who do not have official records or evidence of immunity
• Governments should provide free and accessible hepatitis B and hepatitis C care, including diagnosis and antiviral therapy, as well as harm reduction services where needed. These services can be provided by a network of designated healthcare settings that take into account the language, culture and mental health needs of refugees and may be best provided for refugees when settled in the host country.
• Linkage to care with local services for further clinical evaluation and assessment for treatment should be ensured for all HBsAg-positive and/or HCV RNA-positive individuals.
• It is essential that patients already on treatment for hepatitis B and/or hepatitis C should continue treatment. Therapy for hepatitis B and hepatitis C should be newly initiated for all individuals who meet the criteria for therapy, in accordance with EASL clinical practice guidelines or local clinical guidelines.

The statement makes no recommendations regarding access to harm reduction services, including opioid substitution treatment (OST). Coverage of OST in Ukraine is very low – only 5% of people who inject drugs were receiving OST in 2021. The Eurasian Harm Reduction association has published information on services available for refugees – including harm reduction and OST – in the Baltic states, Czechia, Slovakia, Poland, Moldova, Romania, Hungary, Turkey and Italy.

For those displaced within Ukraine who need antiretroviral therapy or OST, the Ukrainian Ministry of Health is working with local clinics and NGOs such as the Alliance for Public Health and 100% Life to support access to treatment. This includes those who have lost their documents and/or who previously accessed treatment via private health care. Hotlines have been established to provide advice to people with HIV and TB, drug dependency and OST, and viral hepatitis, in Ukrainian. There is also a lot more information on the 100% Life Facebook page, in Ukrainian.

Non-governmental Ukrainian, regional and international organisations in co-operation with government agencies in Ukraine have organised an external service to help Ukrainians with access to treatment for HIV, TB and hepatitis around the world. Information on HELPnow is available here (in Ukrainian). Requests can be made via Telegram, email, Instagram or Facebook.

In response to the crisis, the European Test Finder – a website listing testing services for HIV, viral hepatitis and sexually transmitted infections throughout Europe – is expanding to provide details of facilities offering HIV treatment, OST, TB testing and TB treatment. For the moment, coverage varies from country to country. The Test Finder is available in English, Ukrainian, Russian, Hungarian, Polish, Romanian and Slovak.

Detailed information on services available for refugees from Ukraine living with HIV in European countries can be found at aidsmap.com in English, Russian or Ukrainian. This includes information on access to harm reduction services and general support for refugees.