Theme: Models of Care Year: 2024
Background: The Treatment as Prevention for Hepatitis C (TraP HepC) program in Iceland was launched in 2016. Despite high engagement rates across the cascade of care during the Trap HepC program, new infections and re-infections among people who inject drugs (PWID) remain a challenge and require continued efforts and innovative approaches.
Description of model of care: A nurse-led model of care providing community-based HCV testing and treatment through outreach services. This intersectoral model of care was developed and piloted by outpatient nurses, a hospital outreach nurse and the Icelandic Red Cross mobile needle and syringe program (IRC-NSP). It provided HCV testing and treatment, adherence support, and used incentives to engage the most underserved. Encounter sites included homes of frequent IRC-NSP users, homeless shelters, and soup kitchens. Adherence support included weekly follow-up visits and use of pill dispensers. At the time of screening and every 4 weeks during treatment a €32 shopping mall gift card was offered as an incentive.
Effectiveness: From November 2022 and to May 2023, 236 interactions were recorded by outreach services across 26 service days. A total of 76 clients were tested for HCV, of which 20% (15/76) were HCV RNA positive. Treatment was initiated for 100% (15/15) in addition to 3 others with a previously diagnosed HCV infection. Among the 18 who initiated treatment 72% (13/18) completed 12 weeks of treatment, and 67% (12/18) achieved a sustained virological response.
Conclusion and next steps: This nurse-led intersectoral model of care was effective in delivering community-based, person-centered HCV testing and treatment for the most underserved PWID. Collaboration between hospital-associated nurses and IRC-NSP workers with established and trusted client relationships was considered key to its success. Future efforts should emphasize scaling up of nurse-led models of care delivering HCV testing, treatment, and adherence support in accessible settings.