Historique
Article de Périodique
Reaching hard-to-reach people who use drugs: A community-based strategy for the elimination of hepatitis C (2022)
Auteur(s) :
N. NAGOT ;
M. D'OTTAVI ;
C. QUILLET ;
A. DEBELLEFONTAINE ;
J. CASTELLANI ;
N. LANGENDORFER ;
B. HANSLIK ;
S. GUICHARD ;
R. BAGLIONI ;
V. FAUCHERRE ;
E. TUAILLON ;
G. P. PAGEAUX ;
D. LAUREILLARD ;
H. DONNADIEU-RIGOLE
Article en page(s) :
ofac181
Refs biblio. :
38
Domaine :
Drogues illicites / Illicit drugs
Langue(s) :
Anglais
Discipline :
MAL (Maladies infectieuses / Infectious diseases)
Thésaurus géographique
FRANCE
Thésaurus mots-clés
HEPATITE
;
INTERVENTION
;
POPULATION CACHEE
;
COUT
;
USAGER
;
COCAINE
;
HEROINE
;
PRODUIT ILLICITE
;
CAPTURE-RECAPTURE
;
DEPISTAGE
Autres mots-clés
Résumé :
BACKGROUND: Elimination of hepatitis C virus (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 community-based, respondent-driven sampling (RDS) survey, coupled with HCV screening and immediate treatment, could be efficient to detect and cure current 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 hepatitis B virus, HCV, and human immunodeficiency virus and benefited from onsite 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: Five hundred fifty-four participants were enrolled. Most were male (78.8%) with a median age of 39 years (interquartile range, 33-46). Cocaine (73.1%) and heroine (46.8%) were the main drugs consumed. Overall, 32.6% of PWUD (N = 181) were HCV seropositive, 49 (27.1%) of which had detectable HCV ribonucleic acid and were thus eligible for treatment. Ten of these patients had severe fibrosis. Hepatitis C virus treatment was initiated for 37 (75.5%) patients, 30 (81.1%) of whom completed their treatment and 27 (73.0%) achieved sustained viral response at week 12. The total cost was 161 euros € per screened patient and 1816€ per patient needing treatment.
CONCLUSIONS: A community-based RDS survey approach, involving peers, proved efficient and cost-effective to reach and cure PWUD for HCV. This innovative strategy could be key for the final step of HCV elimination.
Clinical trial registration: ClinicalTrials.gov, NCT04008927.
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 hepatitis B virus, HCV, and human immunodeficiency virus and benefited from onsite 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: Five hundred fifty-four participants were enrolled. Most were male (78.8%) with a median age of 39 years (interquartile range, 33-46). Cocaine (73.1%) and heroine (46.8%) were the main drugs consumed. Overall, 32.6% of PWUD (N = 181) were HCV seropositive, 49 (27.1%) of which had detectable HCV ribonucleic acid and were thus eligible for treatment. Ten of these patients had severe fibrosis. Hepatitis C virus treatment was initiated for 37 (75.5%) patients, 30 (81.1%) of whom completed their treatment and 27 (73.0%) achieved sustained viral response at week 12. The total cost was 161 euros € per screened patient and 1816€ per patient needing treatment.
CONCLUSIONS: A community-based RDS survey approach, involving peers, proved efficient and cost-effective to reach and cure PWUD for HCV. This innovative strategy could be key for the final step of HCV elimination.
Clinical trial registration: ClinicalTrials.gov, NCT04008927.
Affiliation :
Pathogenesis and Control of Chronic & Emerging Infections, University of Montpellier, Montpellier, France
Department of Addiction Medicine, Montpellier University Hospital, Montpellier, France
Association of Marginality and Drug Addiction (AMT), Montpellier, France
Department of Hepatology and Gastroenterology, Montpellier University Hospital, Montpellier, France
Department of Addiction Medicine, Montpellier University Hospital, Montpellier, France
Association of Marginality and Drug Addiction (AMT), Montpellier, France
Department of Hepatology and Gastroenterology, Montpellier University Hospital, Montpellier, France