Low-Threshold Hepatitis C Treatment for People Who Inject Drug – How to Ensure Compliance and Treatment Success

Author: Backe, Vennesland, Wüsthoff, Ulstein, Dalgard

Theme: Clinical Research Year: 2016


Backe Ø1, Vennesland K1, Wüsthoff LE1, Ulstein K1, Dalgard O2,3

1 City of Oslo, Agency for Social and Welfare Services, 2 University of Oslo, 3Akershus University Hospital

Introduction: Approximately 50% of people who inject drugs (PWID) in Oslo have chronic HCV infection. Treatment uptake remains low despite changes in national treatment guidelines recommending treatment to all with significant liver fibrosis or cirrhosis (SLF/C). In 2013 our group initiated a Hepatitis C street-clinic in Oslo to provide HCV testing and treatment for PWID. Our aim for this methodology paper is to describe important factors needed to succeed with this work.

Methods: The clinic is located together with other low threshold social- and health-services. It`s operated by two nurses, a part-time physician and a specialist in liver diseases one day every second week. The model of care is patient-centric with flexible staff, extensive use of existing networks, outreach work and tailored treatment plans. The nurses have long experience in low-threshold work and knowledge of the relevant services in Oslo which are utilized in the daily support of PWID. They draw blood and operate a mobile Fibroscan allowing them to do all investigations needed at different locations. The Salvation Army’s Street Hospital is part of the project and provides in-house treatment when needed.

Results: 273 patients have been tested. Eighty-two% (n=151) of 185 patients with chronic infection have been evaluated using fibroscan (6 of these were referred for biopsies). 45 of 70 patients have received treatment. One patient treated with interferon did not complete the treatment due to side effects, two died of unrelated causes, and one relapsed. We are left with a SVR of 81%. 16 patients with genotype 3 are awaiting new treatment regimens.

Conclusions: Treating hepatitis C amongst PWID in a low-threshold health-service is feasible. It requires flexibility and close collaboration with the patients and their network.

Disclosure of Interest Statement: The clinic has access to a fibroscan machine donated by Abbvie to The Salvation Army.

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