Peer support in small towns: A decentralized mobile Hepatitis C virus clinic for people who inject drugs.
hepatitis C virus
peer support
people who inject drugs
point of care
treatment
Journal
Liver international : official journal of the International Association for the Study of the Liver
ISSN: 1478-3231
Titre abrégé: Liver Int
Pays: United States
ID NLM: 101160857
Informations de publication
Date de publication:
06 2022
06 2022
Historique:
revised:
20
03
2022
received:
19
08
2021
accepted:
29
03
2022
pubmed:
2
4
2022
medline:
11
6
2022
entrez:
1
4
2022
Statut:
ppublish
Résumé
New models of HCV care are needed to reach people who inject drugs (PWID). The primary aim was to evaluate HCV treatment uptake among HCV RNA positive individuals identified by point-of-care (POC) testing and liver disease assessment in a peer-driven decentralized mobile clinic. This prospective study included consecutive patients assessed in a mobile clinic visiting 32 small towns in Southern Norway from November 2019 to November 2020. The clinic was staffed by a bus driver and a social educator offering POC HCV RNA testing (GeneXpert®), liver disease staging (FibroScan® 402) and peer support. Viremic individuals were offered prompt pan-genotypic treatment prescribed by local hospital-employed specialists following a brief telephone assessment. Among 296 tested individuals, 102 (34%) were HCV RNA positive (median age 51 years, 77% male, 24% advanced liver fibrosis/cirrhosis). All participants had a history of injecting drug use, 71% reported past 3 months injecting, and 37% received opioid agonist treatment. Treatment uptake within 6 months following enrolment was achieved in 88%. Treatment uptake was negatively associated with recent injecting (aHR 0.60; 95% CI 0.36-0.98), harmful alcohol consumption (aHR 0.44; 95% CI 0.20-0.99), and advanced liver fibrosis/cirrhosis (aHR 0.44; 95% CI 0.25-0.80). HCV RNA prevalence increased with age (OR 1.81 per 10-year increase; 95% 1.41-2.32), ranging from 3% among those <30 years to 55% among those ≥60 years. A peer-driven mobile HCV clinic is an effective and feasible model of care that should be considered for broader implementation to reach PWID outside the urban centres.
Sections du résumé
BACKGROUND & AIMS
New models of HCV care are needed to reach people who inject drugs (PWID). The primary aim was to evaluate HCV treatment uptake among HCV RNA positive individuals identified by point-of-care (POC) testing and liver disease assessment in a peer-driven decentralized mobile clinic.
METHODS
This prospective study included consecutive patients assessed in a mobile clinic visiting 32 small towns in Southern Norway from November 2019 to November 2020. The clinic was staffed by a bus driver and a social educator offering POC HCV RNA testing (GeneXpert®), liver disease staging (FibroScan® 402) and peer support. Viremic individuals were offered prompt pan-genotypic treatment prescribed by local hospital-employed specialists following a brief telephone assessment.
RESULTS
Among 296 tested individuals, 102 (34%) were HCV RNA positive (median age 51 years, 77% male, 24% advanced liver fibrosis/cirrhosis). All participants had a history of injecting drug use, 71% reported past 3 months injecting, and 37% received opioid agonist treatment. Treatment uptake within 6 months following enrolment was achieved in 88%. Treatment uptake was negatively associated with recent injecting (aHR 0.60; 95% CI 0.36-0.98), harmful alcohol consumption (aHR 0.44; 95% CI 0.20-0.99), and advanced liver fibrosis/cirrhosis (aHR 0.44; 95% CI 0.25-0.80). HCV RNA prevalence increased with age (OR 1.81 per 10-year increase; 95% 1.41-2.32), ranging from 3% among those <30 years to 55% among those ≥60 years.
CONCLUSIONS
A peer-driven mobile HCV clinic is an effective and feasible model of care that should be considered for broader implementation to reach PWID outside the urban centres.
Identifiants
pubmed: 35362660
doi: 10.1111/liv.15266
pmc: PMC9543121
doi:
Substances chimiques
Antiviral Agents
0
RNA
63231-63-0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1268-1277Informations de copyright
© 2022 The Authors. Liver International published by John Wiley & Sons Ltd.
Références
Liver Int. 2022 Jun;42(6):1268-1277
pubmed: 35362660
Nat Rev Gastroenterol Hepatol. 2016 Jun;13(6):338-51
pubmed: 27147491
Int J Drug Policy. 2020 Jun;80:102734
pubmed: 32470849
Lancet Infect Dis. 2016 Dec;16(12):1385-1398
pubmed: 27665254
Int J Drug Policy. 2021 Jun;92:103134
pubmed: 33517130
J Viral Hepat. 2014 May;21 Suppl 1:1-4
pubmed: 24713003
J Hepatol. 2018 Mar;68(3):402-411
pubmed: 29080808
PLoS One. 2014 Jul 28;9(7):e103345
pubmed: 25068274
Lancet Gastroenterol Hepatol. 2018 Nov;3(11):754-767
pubmed: 30245064
J Hepatol. 2015 Jul;63(1):237-64
pubmed: 25911335
Harm Reduct J. 2017 Sep 29;14(1):67
pubmed: 28962652
BMC Infect Dis. 2017 Aug 3;17(1):541
pubmed: 28774261
BMJ Open. 2020 Nov 9;10(11):e039724
pubmed: 33168560
Nat Rev Gastroenterol Hepatol. 2017 Nov;14(11):641-651
pubmed: 28831184
Clin Infect Dis. 2013 Aug;57 Suppl 2:S39-45
pubmed: 23884064
Addiction. 2019 Jan;114(1):150-166
pubmed: 30035835
Lancet Gastroenterol Hepatol. 2017 Jul;2(7):514-520
pubmed: 28442271
Int J Drug Policy. 2017 Sep;47:34-46
pubmed: 28797498
Lancet Gastroenterol Hepatol. 2018 Mar;3(3):153-161
pubmed: 29310928
MMWR Morb Mortal Wkly Rep. 2015 Dec 11;64(48):1337-41
pubmed: 26655918
J Viral Hepat. 2020 Jul;27(7):709-714
pubmed: 32106345
Liver Int. 2022 Feb;42(2):309-319
pubmed: 34767680
PLoS One. 2015 Nov 12;10(11):e0142770
pubmed: 26562516
Harm Reduct J. 2008 Feb 25;5:8
pubmed: 18298862
PLoS Med. 2021 Jun 1;18(6):e1003653
pubmed: 34061883
Trials. 2020 Jun 15;21(1):524
pubmed: 32539853
Int J Drug Policy. 2021 Oct;96:103165
pubmed: 33642182
Soc Sci Med. 2011 May;72(9):1472-81
pubmed: 21481509
Eur J Gastroenterol Hepatol. 2010 Mar;22(3):270-7
pubmed: 20425880
Lancet Gastroenterol Hepatol. 2020 Sep;5(9):809-818
pubmed: 32526210
Am J Med. 2013 Aug;126(8):718-22
pubmed: 23786667
BMC Med. 2019 Apr 1;17(1):71
pubmed: 30929642
Nat Rev Gastroenterol Hepatol. 2013 Sep;10(9):553-62
pubmed: 23817321
J Viral Hepat. 2020 Dec;27(12):1270-1283
pubmed: 32964615
Lancet Gastroenterol Hepatol. 2019 Feb;4(2):135-184
pubmed: 30647010
J Community Health. 2014 Oct;39(5):922-34
pubmed: 25135842
Int J Drug Policy. 2007 Oct;18(5):406-10
pubmed: 17854729
Lancet Glob Health. 2017 Dec;5(12):e1192-e1207
pubmed: 29074409
J Infect Dis. 2013 Mar;207 Suppl 1:S19-25
pubmed: 23390301
Int J Drug Policy. 2019 Dec;74:236-245
pubmed: 31706159
J Viral Hepat. 2020 Jun;27(6):593-601
pubmed: 31999866
J Viral Hepat. 2018 Dec;25(12):1452-1461
pubmed: 29998522
Singapore Med J. 2022 Feb;63(2):86-92
pubmed: 32729280
J Infect Dis. 2018 May 25;217(12):1889-1896
pubmed: 29534185