Implementation Of A Nurse –Led Model Of Care To Treat People Who Inject Drugs (Pwid) For Hcv In The Community

Author: Allardice K, Von Bibra S, Doyle JS, Dietze P M, Desmond P, Stoove M, McBryde E, Higgs P, Thompson AJ, Hellard ME

Theme: Clinical Research Year: 2017

The Hepatitis C Treatment and Prevention (TAP) Study evaluates the effectiveness of an Nurse-led, outreach model to improve hepatitis C treatment uptake by current People Who Inject Drugs (PWID) and their injecting networks.
PWID are recruited by Nurses from a study van in various locations in Melbourne. Primary participants invite their injecting networks to become secondary participants. Referrals come through the SuperMIX cohort, or as self-referrals. Participants are randomly allocated to immediate or deferred treatment with sofosbuvir/velpatasvir. Nurses perform pre-treatment assessments (including elastography) and offer treatment to eligible participants. Follow-up is for 18 months to monitor treatment outcomes, re-infection or resistance to therapy. Social and behavioural data are collected at each visit.
316 PWID have been screened, comprising 163 Primary and 153 Secondary participants. 112 have started and 72 have completed treatment. Some treated participants report an increased sense of well-being and changing their injecting practices to “stay clean”. Many have stated that they value the chance to get treatment through the study, as they normally don’t engage with other health care services. Referral to tertiary health services has been facilitated for those needing treatment outside the study criteria with some degree of success. Eighty-eight participants are screening failures. Mental health issues, homelessness and incarceration impact negatively on being able to attend study visits. Mobile phone numbers change frequently. Finding suitable locations for the van has proven problematic and is dependent on the goodwill of Local Councils and businesses.
While homelessness and mental health issues may be obstacles to accessing HCV treatment, we have shown that a Nurse-led outreach model provides the platform for treatment for many PWID. Its’ success relies heavily on existing relationships and continued rapport building, but also on the support of local authorities, businesses and PWID themselves.

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