Hepatitis C Virus Infection Epidemiology among People Who Inject Drugs in Europe: A Systematic Review of Data for Scaling Up Treatment and Prevention

Background: People who inject drugs (PWID) are a key population affected by hepatitis C virus (HCV). Treatment options are improving and may enhance prevention; however access for PWID may be poor. The availability in the literature of information on seven main topic areas (incidence, chronicity, genotypes, HIV co-infection, diagnosis and treatment uptake, and burden of disease) to guide HCV treatment and prevention scale-up for PWID in the 27 countries of the European Union is systematically reviewed. Methods and Findings: We searched MEDLINE, EMBASE and Cochrane Library for publications between 1 January 2000 and 31 December 2012, with a search strategy of general keywords regarding viral hepatitis, substance abuse and geographic scope, as well as topic-specific keywords. Additional articles were found through structured email consultations with a large European expert network. Data availability was highly variable and important limitations existed in comparability and representativeness. Nine of 27 countries had data on HCV incidence among PWID, which was often high (2.7-66/100 person-years, median 13, Interquartile range (IQR) 8.7–28). Most common HCV genotypes were G1 and G3; however, G4 may be increasing, while the proportion of traditionally ‘difficult to treat’ genotypes (G1+G4) showed large variation (median 53, IQR 43–62). Twelve countries reported on HCV chronicity (median 72, IQR 64–81) and 22 on HIV prevalence in HCV-infected PWID (median 3.9%, IQR 0.2–28). Undiagnosed infection, assessed in five countries, was high (median 49%, IQR 38–64), while of those diagnosed, the proportion entering treatment was low (median 9.5%, IQR 3.5–15). Burden of disease, where assessed, was high and will rise in the next decade. Conclusion: Key data on HCV epidemiology, care and disease burden among PWID in Europe are sparse but suggest many undiagnosed infections and poor treatment uptake. Stronger efforts are needed to improve data availability to guide an increase in HCV treatment among PWID

Unboxing the vague notion of policy goals: comparison of Croatian public policies

IN ENGLISH: This study aims at empirically improving public policy theory by unfolding the concept of policy goals and contributing to their classifications. The research focuses on the thematic dimension of policy goals and investigates 11 Croatian governmental strategies using qualitative content analysis. The research identifies original policy goal types and classifies them into sector‐, process‐, evaluation‐, instrument‐, and value‐oriented goals. Article concludes with a more comprehensive definition of policy goals, as governmental statements about desired futures in relation to specific sectoral purposes, values, and principles in democratic political systems, policymaking process improvements, necessary instrumental innovations, and evaluation standards that should be fulfilled. The application of this definition and developed goals’ classification reveals that elements of policy‐process theories, evaluation research, policy design theory and instrument analysis, democracy theory, and sector‐specific research need to be synthesized to better understand the concept of policy goals and to advance their research. --------------- IN CROATIAN: Cilj ovog članka je empirijski poboljšati teoriju javnih politika razvijanjem koncepta ciljeva politike i doprinosom njihovoj klasifikaciji. Istraživanje se fokusira na tematsku dimenziju ciljeva politike i istražuje 11 hrvatskih vladinih strategija pomoću kvalitativne analize sadržaja. Istraživanje identificira izvorne vrste ciljeva politike i klasificira ih na ciljeve usmjerene na sektor, proces, procjenu, instrument i vrijednost. Članak završava opsežnijom definicijom ciljeva politike, kao vladine izjave o željenoj budućnosti u odnosu na određene sektorske svrhe, vrijednosti i načela u demokratskim političkim sustavima, poboljšanja procesa donošenja politika, potrebne instrumentalne inovacije i standarde ocjenjivanja koje treba ispuniti. Primjena ove klasifikacije i klasifikacija razvijenih ciljeva otkriva da elemente teorija političkih procesa, istraživanja evaluacije, teorije dizajna politika i analize instrumenata, teorije demokracije i specifičnih sektorskih istraživanja treba sintetizirati kako bi se bolje razumio koncept ciljeva politike i kako bi unaprijedili svoja istraživanja