A low threshold harm reduction centre in the historic centre of Lisbon targeting people who inject drugs (PWID) and delivering integrated services for viral hepatitis, HIV, and STIs.
- Walk-in educational sessions on safer drug consumption (peer or nurse-led);
- Integrated rapid testing for HIV, hepatitis B (HBV), hepatitis C (HCV), and syphilis with opt-out counseling;
- Point-of-care PCR reflex testing for HIV and HCV;
- Linkage (and retention) to healthcare and peer navigation services;
- Walk-in nursing and medical appointments;
- Other services such as drop-in services and distribution of prevention tools.
This initiative was motivated by the high prevalence of HCV infections among the PWID tested at the centre, the small proportion of PWID who initiate HCV treatment in primary care settings, and the significant number of patients who do not complete their treatment course after treatment initiation.
As many of those diagnosed continued to come to GAT IN Mouraria for harm reduction or drop-in services in spite of their treatment status, this was an opportunity to (re)connect them to care for HCV at the centre. Prior to the implementation of the project, a rapid survey on the HCV treatment cascade found that, following their positive diagnosis for HCV, 85% of PWID accepted a hospital referral, 76% reached a physician, and 33% obtained a HCV treatment prescription. However, only 24% initiated treatment and just 11% completed it. This shows that conventional community-to-hospital care referral had a low rate of HCV treatment initiation and completion.
First, to ensure that the project ran smoothly, GAT and CHULC established an agreement on care responsibilities. Second, GAT IN Mouraria provided training to their staff (mostly nurses) in point-of-care HCV PCR testing, followed by training in the use of centre equipment. Third, peer involvement was prompted to ensure linkage and retention in the decentralised HCV treatment consultations, including locating those lost to follow-up from hospital-based consultations. Finally, in addition to routine clinical team meetings and service monitoring, the following healthcare provision was established:
A. GAT was responsible for
- Point-of-care PCR HCV confirmation of infections;
- Booking decentralised consultations;
- Sample collection for analysis;
- Medication regimen adherence.
B. CHULC was responsible for
- HCV treatment care and monitoring;
- Laboratory samples transport and processing;
- Medication dispensing and transport to GAT.
From September 2020 to May 2022, a total of 73 PWID attended the decentralised consultation: 31 patients were cured from HCV, 30 are still undergoing treatment, and only 12 were lost to follow-up.
Among PWID, the delivery of HCV treatment at harm-reduction services can lead to significantly better completion rates than in routine clinical settings..
Public and private funding.