treat hepatitis C in a mobile clinic study€¦ · Copenhagen, Denmark T’N’T HepC – the...
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~1.3 million people in Copenhagen Copenhagen, Denmark T’N’T HepC – the Copenhagen test and treat hepatitis C in a mobile clinic study Jeffrey Lazarus, Anne Øvrehus, Jonas Demant, Louise Krohn-Dehli and Nina Weis 1. Øvrehus A, et al. Addiction 2019;114:494–503; 2. Øvrehus A, personal communication; 3. Bajis S, et al. Int J Drug Policy 2017;47:34–46 This initiative has received part funding from Gilead Sciences This meeting has been organised and funded by Gilead Sciences Europe Ltd. Date of preparation: September 2019. HCV/IHQ/19-02//1239bv © Gilead Sciences Europe Ltd Enhancing the HCV cascade of care for people who inject drugs (PWID) 35% prevalence of HCV amongst PWID in Denmark 1 Why is the model needed? 2 Aim: To engage PWID who are not accessing testing and treatment for HCV through opioid substitution therapy (OST) centres or conventional care Peer-led models of care, such as the hepatitis C van, are effective in initiating treatment in PWID. They bring testing options to the individual and assist referrals to fast-track clinics to deliver individualised treatment to the patient. Outcomes 2 What is the model and how does it work? 2 Interventions used to enhance HCV testing, linkage to care and treatment uptake • Multidisciplinary mobile clinic offering point of care testing, counselling and education for PWID • Mobile, point of care, rapid HCV antibody and reflex HCV RNA testing • Peer-led, patient navigation and facilitated referrals (e.g. fast-track hospital clinics) for further HCV evaluation Peer support has been shown to be effective in enhancing screening and linkage to care 3 To engage PWID in the community in hepatitis C testing and treatment Restrictions on treatment reimbursements were removed in November 2018 but prescriptions only made by hospital-based physicians Multiple visits are often required before treatment initiation, resulting in a decrease in initiating therapy Peer-led HCV van providing education, harm reduction and screening Treatment initiated Visits locations with high numbers of PWID RNA+ patients are escorted by peers to hospital for FibroScan ® , genotyping and consultation Patients screened with rapid antibody test If postive, GeneXpert ® point of care finger prick test for HCV RNA +ve Test Refer Treat 233 screened 36 RNA+ patients 12 started treatment 7 referred but not yet seen 17 not treated • 2 died • 2 in prison • 3 lost to follow-up • 2 severe comorbidities/ declined referral • 8 without legal residence in country Lessons learnt: Peers can engage PWID on the street for testing and treatment Staying in one location for a long period of time is beneficial as many people take up treatment after multiple visits and communication is maintained Many PWID are unaware that effective and well-tolerated HCV therapy is available Many people think HCV is asymptomatic, harmless and not necessary to treat HCV The largest group unable to access treatment are migrants without legal residence in Denmark
Transcript of treat hepatitis C in a mobile clinic study€¦ · Copenhagen, Denmark T’N’T HepC – the...
~1.3 million people in Copenhagen
Copenhagen, Denmark
T’N’T HepC – the Copenhagen test and treat hepatitis C in a mobile clinic studyJeffrey Lazarus, Anne Øvrehus, Jonas Demant, Louise Krohn-Dehli and Nina Weis
1. Øvrehus A, et al. Addiction 2019;114:494–503; 2. Øvrehus A, personal communication; 3. Bajis S, et al. Int J Drug Policy 2017;47:34–46
This initiative has received part funding from Gilead SciencesThis meeting has been organised and funded by Gilead Sciences Europe Ltd.
Date of preparation: September 2019. HCV/IHQ/19-02//1239bv © Gilead Sciences Europe Ltd
Enhancing the
HCV cascadeof care
for people who inject drugs (PWID)
35% prevalence of
HCV amongst PWIDin Denmark1
Why is the model needed?2
Aim: To engage PWID who are not accessing testing and treatment for HCV through opioid substitution therapy (OST) centres or conventional care
Peer-led models of care, such as the hepatitis C van, are effective in initiating treatment in PWID. They bring testing options to the individual and assist referrals to fast-track clinics to deliver
individualised treatment to the patient.
Outcomes2
What is the model and how does it work?2
Interventions used to enhance HCV testing, linkage to care and treatment uptake• Multidisciplinary mobile clinic offering point of care testing, counselling and education for PWID• Mobile, point of care, rapid HCV antibody and reflex HCV RNA testing • Peer-led, patient navigation and facilitated referrals (e.g. fast-track hospital clinics) for further HCV evaluation
Peer support has been shown to be
effective in enhancing screening and linkage to care3
To engage PWID in the community in hepatitis C testing and treatment
Restrictions on treatment reimbursements were
removed in November 2018 but prescriptions only madeby hospital-based physicians
Multiple visits are often required before
treatment initiation, resulting in a decrease
in initiating therapy
Peer-led HCV vanproviding education, harm reduction and screening
Treatmentinitiated
Visits locations with high numbers of PWID
RNA+ patients are escorted by peers to hospital for FibroScan®,
genotyping and consultation
Patients screened with rapid antibody test
If postive, GeneXpert® point of care finger
prick test for HCV RNA
+ve
Test
Refer
Treat
233 screened
36 RNA+ patients
12 started treatment
7 referred but not yet seen
17 not treated
• 2 died• 2 in prison• 3 lost to follow-up• 2 severe comorbidities/ declined referral
• 8 without legal residence in country
Lessons learnt:
Peers can engage PWID on the street for testing and treatment
Staying in one location for a long period of time is beneficial as many people take
up treatment after multiple visits and communication is maintained
Many PWID are unaware that effective and
well-tolerated HCV therapy is available
Many people think HCV is asymptomatic,
harmless and not necessary to treat
HCV
The largest group unable to access
treatment are migrants without legal residence
in Denmark
