The Mobile Hepatitis Screening Program: An Innovative Project among People who Use Drugs in Paris Region

Author: Avril E, Volant J, Votran A

Theme: Epidemiology & Public Health Research Year: 2015

Many HCV infected drug users are not treated because they fear treatment, examinations or because they underestimate the severity of the disease.
The FibroScan® measures the liver stiffness and allows the liver fibrosis diagnosis. It is non invasive, rapid (5-10 minutes) and gives an instant result. Integrated in a street outreach program, consultations and interviews are opportunities for screening but also counseling and linkage to care.

Since 2011, Gaia reaches around 25 OST programs and/or drop in centers. We propose medical exams and awareness activities on hepatitis for PWUD, and training for health and social workers. We spend time to explain the main risks that can exist in terms of virus transmission and propose counseling sessions regarding the risks they may take. Sharing paraphernalia such as crack pipes, tourniquets, cottons, is very often unknown as a very high risk.
In 2013, we have started screening HIV and HCV with rapid tests and HCV PCR with dried blood spot (DBS) for PWuD with extreme damaged veins which can prevent from a classic blood sample.

We have realized 1346 exams with 82% of men. Their last screening dated an average of 2 years ½ old but almost half declare having taken a “risk” after it. 37% of PWuD with HCV have no medical follow up. In particular, they face difficulties to access PCR (20% have no healthcare insurance).
8% among them have elasticity score above 12 kPa which means a severe liver fibrosis. Almost half of the patients have regular alcohol consumption: more than twice a week with an average of 10 alcohol units per day.

FibroScan®, rapid tests and DBS are real new Harm Reduction tools which are easily performed in mobile units and allow access to very precarious population and improve their linkage to care.

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