A novel hepatitis C intervention in Denmark to test and treat people who inject drugs

Author: Jeffrey Lazarus Anne Øvrehus Jonas Demant Louise Krohn-Deli Nina Weis Jannet van der Veen

Theme: Models of Care Year: 2021

Background: Providing hepatitis C virus (HCV) care for people who inject drugs (PWID) is critical in eliminating HCV, but reaching PWID with traditional healthcare services can be challenging. Combining point-ofcare (PoC) testing with peer support and counselling is a model of care (MoC) that can be effective for PWID. This study aims to investigate if a mobile van equipped with rapid PoC tests for HCV antibodies and RNA could simplify testing and link PWID to care. Description of model of care/intervention: In Copenhagen, Denmark, a peer-led mobile service providing counselling, Ab testing (In-Tech™), and linkage to care was equipped with a PoC HCV-RNA finger-prick test (Xpert HCV Viral Load Finger-Stick Point-of-Care Assay, Cepheid). Eligible HCV-RNA+ individuals were offered assisted referral to a fasttrack hospital clinic for treatment, with peer support as needed. Effectiveness: From 1 May 2019-22 April 2021, 774 people were tested and 72 were HCV-RNA+. Nine additional individuals with HCV infection contacted the service to be linked to care. 63/72 were evaluated at the hospital clinic and 55/72 initiated direct-acting antiviral therapy. The main reasons for not being evaluated for treatment were being undocumented (n= 10) and being lost to follow-up (n= 10). 14/55 were connected to drug treatment services. The peer-led service assisted all treated with communication with the hospital nurse, collecting medicine, and accompaniment to follow-up visits. Conclusion and next steps: We found that a peer-led mobile PoC service is a MoC that can engage PWID in HCV testing and link them to treatment, even during the COVID-19 pandemic. Being an undocumented migrant was a major cause for not accessing care. This poses a challenge for HCV elimination in Denmark due to the risk of onward transmission. The next steps include engaging with health authorities in order to provide care for undocumented migrants. Disclosure of Interest Statement: The mobile clinic is supported by the Danish Helsefonden (Health-Fund) and Sundhedsstyrelsen (Danish Health Authority). This study was supported by AbbVie (grant number SA-02643), Gilead Science (grant number 220001768) and MSD (financial educational grant signed 5/7/2019). JVL acknowledges support to ISGlobal from the Spanish Ministry of Science, Innovation and Universities through the “Centro de Excelencia Severo Ochoa 2019-2023” Programme (CEX2018-000806-S) and from the Government of Catalonia through the CERCA Programme. JVL further acknowledges grants and speaker fees from Gilead Sciences and MSD, and speaker fees from Genfit and Intercept, all outside the submitted work. AØ reports grants, personal fees and other from AbbVie, Gilead Sciences and MSD, outside the submitted work. JD reports grants from AbbVie, Gilead Sciences and MSD, outside the submitted work. NW reports unrestricted grants and personal fees from AbbVie and Gilead Sciences, grants and personal fees from MSD and grants from Bristol Myers Squibb, outside the submitted work. LK-D and JV have nothing to disclose.

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