Crescer Community Intervention Association is a Portuguese NGO, founded in 2001, that implements and develops harm reduction projects in the urban area of Lisbon. Our Harm Reduction intervention stands out from other initiatives, as our outreach teams have been involved with the most vulnerable and segregated members of the public – consumers of psychoactive substances, homeless people, and sex workers – of the city of Lisbon since 2002.  

 Throughout the years of on the field intervention, one of the problems facing our service users has been the high prevalence of contagious infectious diseases (particularly HIV, HCV, and TB). With our field experience, operating daily in the main urban areas of consumption in Lisbon, promoting safer behaviors to approximately 1500 people per year, we are in contact with a group that is shown to be at the highest risk of infection due to their social and behavior vulnerability.  

One challenge for the elimination of TB is its existence in certain pockets of society, concentrated among the most vulnerable, such as the homeless, drug users, alcoholics and some migrant populations. Often these groups, who may be at higher risk of exposure, live in poor conditions or do not have access to healthcare services. 

As a consequence, CRESCER started to assess TB, HIV and HCV infection in places where people were consuming. This was done through sputum and blood collection, and provided a guaranteed link to other health structures, including CDP (pneumological diagnosis centre) for X-ray and medical support.  

In cases of active TB, strategies were used to enhance treatment compliance: providing transport for patients; establishing partnerships with hospitals and associations in order to create access to faster, specialized appointments and ensure medication intake; and providing psychological support.  

At this point we’ve been working to build and even more effective approach to TB and as a part of this, we included TB screening on our Outreach Teams activities in our strategic plan. We believe that this approach helps to overcome barriers to TB treatment. This methodology has proved effective for reaching and screening psychoactive substance users. We’ve also been working closely with the National Health Service in order to redefine the National Health Strategy for TB, together with all the other NGOs that work with vulnerable groups in Lisbon. As advocates, we intend to shorten the gap between vulnerable groups that don’t have access to treatment and the main health structures in order to promote a better quality of care to the entire community. We believe that the next step should be the integration of TB treatment in harm reduction settings to ensure that everyone has access to care. 

 

Blog written by Inês Marinho 

Click image for larger view