Theme: Models of Care Year: 2019
Background: Complete eradication of HCV infection has become a significant challenge with the
availability of very efficient pangenotypic oral treatments. It requires to detect and treat the
population with the highest prevalence of HCV infection (active/substituted drug users, migrants,
highly precarious subjects) not attending classical medical care centres.
Methods: In order to encounter these highly exposed patients mostly present in addiction care
centres, social housing and food distribution associations, we used advanced consultations based on
a “go-to-the-patient” action with a mobile team (a nurse and a physician) to detect and treat HCV
and assess potential liver injury with the following tools: HCV detection : HCV quick detection tests,
dry blood tests and serum samples when possible; liver evaluation using a portable Fibroscan and
serum samples when possible; anonymous questionnaire to evaluate alcohol/drug addiction and
social situation.
Results: During a one-year-action study, 62 patients detected with positive serum HCV RNA .
Patient profile: 29-67 years, median 40 years; male/female 78.8%/21.2%. HCV-monoinfection n=60,
HCV-HIV co-infected n=2. Patients with social security 89%, an income 9%, social financial support
69%, no income: 22%.
Fibrosis stage (Fibroscan elastography): F4 n=3, F3 n=4, F2 n=4, F0-FI n=51 .
Genotype: HCV1a n=27, HCV1b n=2, HCV3 n=20, HCV4 n=2, not tested n= 11.
Anti viral treatment with therapeutic education was performed in 48/62 patients (77.4%) with the
following results: 44/48 (91.7%) sustained virologic response (>12 weeks post-treatment); 4/48
(8.3%) waiting for HCV post-treatment. Excellent treatment tolerance. No drug interaction. There
has been no treatment initiation in 14 patients (23.6%) due to: loss of follow-up n=6 (9.7%), no social
rights n=6 (9.7%), treatment declined by the patient n=2 (3.2%).
Conclusion: These results indicate a high viral eradication rate and encourage increased HCV
detection and treatment using an advanced consultation based on a “go-to-the-patient” action in
these difficult-to-treat patients.
Disclosure of interest Statement: none included