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

Nicolas Nagot, Morgana D'Ottavi, Catherine Quillet, Anne Debellefontaine, Joëlle Castellani, Nicolas Langendorfer, Bertrand Hanslik, Sylvain Guichard, René Baglioni, Vincent Faucherre, Edouard Tuaillon, Georges-Philippe Pageaux, Didier Laureillard, Hélène Donnadieu-Rigole, Nicolas Nagot, Morgana D'Ottavi, Catherine Quillet, Anne Debellefontaine, Joëlle Castellani, Nicolas Langendorfer, Bertrand Hanslik, Sylvain Guichard, René Baglioni, Vincent Faucherre, Edouard Tuaillon, Georges-Philippe Pageaux, Didier Laureillard, Hélène Donnadieu-Rigole

Abstract

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.

Keywords: Costs and cost analysis; drug users; hepatitis C; intervention; mass screening.

© The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

Figures

Figure 1.
Figure 1.
Recruitment rate per week of respondent-driven sampling survey, September 15, 2020 to November 27, 2020.
Figure 2.
Figure 2.
Participants flow chart. Abbreviations: AME, Aide médicale de l'Etat (Medical financial assistance from the government); HCV, hepatitis C virus; RDS, respondent-driven sampling; RNA, ribonucleic acid.

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Source: PubMed

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