Reaching Hard to Reach People Who Use Drugs: A Community-Based Strategy for the Elimination of Hepatitis C in High-Income Settings

Author: Nicolas Nagot Morgana D'Ottavi Catherine Quillet Anne Debellefontaine Joelle Castellani Nicolas Langendorfer Bertrand Hanslik Sylvain Guichard Rene Baglioni Vincent Faucherre Edouard Tuaillon Georges-Philippe Pageaux Rene Didier Laureillard Helene Donnadieu

Theme: Clinical Research Year: 2022

Background: Elimination of HCV among people who use drugs (PWUD) remains a challenge even in
countries in which HCV care is provided free of cost. We assessed whether an innovative communitybased respondent-driven sampling (RDS) survey, coupled with HCV screening and immediate
treatment, could be efficient to detect and cure active PWUD with chronic HCV in a large city of
Southern France.
Methods: At a community site with peers, PWUD (cannabis not included) were enrolled after
confirmation by a urine drug test. Participants were then screened for HBV/HCV/HIV and benefited
from on-site HCV treatment evaluation and prescription. Peer support was provided during
treatment, and a systematic visit was scheduled 12 weeks after the end of treatment. The cost of the
intervention was estimated.
Results: 554 participants were enrolled. Most were male (78.8%) with a median age of 39 years (IQR:
33-46). Cocaine (73.1%) and heroine (46.8%) were the main drugs consumed. Overall, 32.6% of
PWUD (N=181) were HCV seropositive, of which 49 (27.1%) had detectable HCV RNA and were thus
eligible for treatment. Ten of these patients had severe fibrosis. HCV treatment was initiated for 37
(75.5%) patients among whom 30 (81.1%) completed their treatment and 27 (73.0%) achieved
sustained viral response at week 12. The total cost was 161€ per screened patient and 1,816€ per
patient needing treatment.
Conclusions: Community-based RDS survey approach, involving peers, proved efficient and costeffective to reach and cure PWUD for HCV. This innovative strategy could be key for the final step of
HCV elimination.
Disclosure of Interest: None

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