Theme: Clinical Research Year: 2015
In Paris region HCV prevalence is 44% among drug users, 15% of the population living with HVC found out their chronicle infection at an advanced stage (cirrhosis). Each year, Gaia’s low threshold addiction centre receives around 1000 patients; most of them are very precarious PWUD.
Many challenges regarding this population remain, including complex and multiple addictions, psychiatric co-morbidities, fear of institutions as well as lack of residence permit, health insurance and housing.
The HCV care program includes an assessment of drug consumptions (OST, psychiatric treatment, harm reduction, acupuncture); capacity building sessions on hepatitis, liver, alcohol; assessment of liver fibrosis through transient elastography (Fibroscan) and biological analysis and development of a by pass consultation in a reference hospital for hepatitis C. As well, the program proposes social support (housing, health care insurance, vouchers…) and peer support. Practically, Gaia’s GP prescribe PegInF/RBV directly, weekly consultation with nurse or GP (reassurance, monitoring for side effects). The treatment delivery is mainly weekly or monthly.
Since 2012, among all the drug users visiting Gaia, 250 HCV rapid tests were done along with 118 dried blood spots. 79 had positive antibodies, and 58 RNA PCR positive. In the same period, recruiting other users from the NEP, already tested, 80 persons were HCV treated in the centre with good adherence, little treatment interruptions, no re infection among them.
These services have improved access to HCV treatment. Until now, barriers to care were difficulties to access to social and medical services; negative perceptions. Our comprehensive care has increased the number of treated patients.
Today, GP are not allowed to prescribe the new molecules: prescription is made by a hospital commission only for severe fibrosis. This could lead to break linkage to care and postpone virus elimination at a public health level.