The main objective of the Project is to provide a basis for planning a long-term strategy for preventing HCV and combating hepatitis C in Poland. The objective will be fulfilled by specifying epidemiological situation, by risk assessment of infections in medical care facilities and in sector with an increased risk of transmission of blood-borne infections, by preparation of guidelines for routine diagnostic test, especially among psychoactive substances users. The objective will be also fulfilled by develop and implementation of educational program on social awareness of HCV infections problems and methods of prevention with particular emphasis of health care workers participation.

Hepatitis C has been recognised by the WHO as one of the biggest global epidemic threads. Due to the long-term asymptomatic course of HCV, the disease has been called as “viral time-bomb” or “silent epidemic”. The disease raises intense concern of medical environment. The WHO indicates, that at least 170 million people are infected in the world (2,2%-3% global population). The prevalence of HCV infection in the world is strongly geographically diversified and ranges from less than 0,1% (Scandinavian countries) to over 20% (Egypt), and in European region is average 1,1-1,3%. The prevalence of active HCV infections in Poland is estimated at 0.6%¹ , which is 230 thousand people infected in the country. This percentage places Poland with an average prevalence factor of this virus among European countries.
The scale of the HCV virus spread problem and its possible implications for public health is clearly highlighted in Europe in recent years. In 2007 Members of European Parliament have published a declaration, which was to sensitize the governments of Member States and the European Commission on risk associated with HCV and to induce to work on improving early detection and access to treatment² . In 2009 was published the results of estimation of the social costs of hepatitis C in European Region of WHO, HCV infections are responsible for 86 thousand deaths a year³ , that is more than double the AIDS and 95% social costs are associated with studies of the diseases, that can be prevented. The authors call for coordination of actions between Member States and indicate the necessity of increasing availability of diagnostic tests for HCV infection and necessity of increasing social awareness of the infections problem.

The dominant route of HCV transmission are blood-borne infections. Studies conducted in 2004 show, that in Poland the primary significance in HCV prevalence had injections made without basic safety rules (both in medical and no medical facilities⁴) . The source of infection may also be reusable equipment used in hospitals and dental clinics, mainly due to disinfection using inadequate methods. For these reasons it is necessary to constantly improve the level of medical staff awareness on their special role to prevention of HCV infections. The group especially vulnerable to iatrogenic infections are dialyzed persons⁵.

Injecting drug users (IDU) are susceptible to blood-borne infection of HCV and in some European countries with higher standards of medical care constitutes 95% all HCV infections⁶ . In Poland the percentage of people infected among IDU is approximately 50%⁷ , but they constitute only 5% – 15% of all reported cases of HCV (National Institute of Public Health – National Institute of Hygiene – no published data).

The risk associated with the beauty treatment (tattoos, piercing) cannot be marginalized, even so the number of beauty treatments is incomparably smaller than the number of medical procedures performed every day. The spread of hepatitis C can also occur in a household contact, during the common use of toiletries (especially when infected person does not have awareness of infection). HCV virus may also spread through vertical route; the risk of infection transmission from mother to a child is approximately 5% and in the case of HIV co-infection, even 15-20%.

Asymptomatic course of HCV lasts for many year as a rule. Without the active screening, most of the infected people will learn about the disease too late for effective drug treatment, then the only treatment option will be a liver transplantation.

“Prevention of HCV infection” Programme will include the five Projects.

Project 1
„Improvement of HCV diagnostics, estimation of HCV prevalence in general population and analysis of factors associated with HCV prevalence”

The main aim will be to improve strategies for HCV diagnosis in general population done at the primary medical care level provided with individual risk assessment. The objectives will be:

• Screening for HCV in a selected group from general population (patients from co-operative primary health care units),
• To provide consultation and refer for further care of persons diagnosed with HCV,
• To deliver individualized information on occurrence of risk factors of transferring blood borne diseases in general population,
• To improve knowledge of the HCV epidemiology in Poland including burden of illness and related risk factors.

Project 2
„Developing evidence based HCV prevention Program for injecting drug users (IDUs) and assessing needs for prevention in this population”.

The main aim will be to reduce risk of HCV infection in the population of injecting drug users (IDUs). The objectives will be:

• To include IDUs population in HCV prevention based on verified experience.
• To increase institutional capacity to response HCV problem among IDUs.

Project 3
„Preliminary programme of routine HCV testing among pregnant women”

The aim of this project will be to improve prevention of the vertical HCV transmission and to reduce harmful clinical consequences for vertically infected children. The objectives will be:

• To assess justifiability and feasibility of routine HCV testing on pregnant women or in defined subgroups of pregnant women based on pilot implementation of examinations in pregnancy care facilities.
• Estimation of HCV prevalence and risk factors based on examinations made in pregnant women in the area of 5 voivodeships.
• Increase of knowledge of obstetrics-gynaecology specialists and primary care physicians on prevention of vertical HCV transmission as well as of management of the new born of an HCV infected mother.

Project 4
„Qualitative evaluation of the risk of HCV infection associated with medical procedures in selected health care units”

Aims of the project:

• Describing procedures and behaviours associated or potentially associated with increased risk of HCV transmission in the health care facilities in Poland.
• Modernization and modification of safety procedures for medical staff,
• Modification of procedures for monitoring and sanitary control carried out by the sanitary services at health care units.

Project 5
„Raising awareness of prevention of blood-borne infections (HCV, HBV, HIV) among providers of services associated with blood-to-blood contact and the general public”

Aims of the Project:

• Effective prevention on transmission of blood-borne infections (HCV, HBV, HIV) in Poland, through improvement the knowledge in area of epidemiology of HCV infections of the employees working in the sectors of higher risk of blood-borne infections transmission, and improvement of skills how to prevent the infections during doing the invasive procedures.
  
• Improving prevention of infections in the performance of procedures.
  
• Increase of awareness of the general public of the hepatitis C problem.
  
• Counteracting the social stigmatization of people with HCV.