Roll out of HEP services for PWID
The Scanvir project that seeks to increase diagnosis and linkage to care of viral hepatitis amongst people who use drugs has been rolled out across many regions in France, such as Nouvelle Aquitaine, Pays de la Loire, and Île de France, after being successfully piloted in the area of Limoges in 2017.
In line with the French Health Ministry’s ambition to achieve the elimination of viral hepatitis as a major public health threat in France by 2025, 5 years earlier than the WHO’s global goal, this project addresses specifically the needs of people who use drugs, a sub-population which has an elevated risk of contracting viral hepatitis.
The “Scanvir” program is an original strategy based on dedicated screening days to create the event “test, treat and cure HCV” in addiction care centers in France, bringing on site innovative screening technologies and offering a muldisciplinary team including not only hepatologists/experts in infectious diseases, but also specialists in addiction therapy, community nurses, social workers and experts in health promotion and disease prevention. Rather than in a hospital, testing (RDTs, point-of-care HCV RNA testing) and treatment takes place in outpatient settings, e.g. addiction centres. Patients are tested for viral hepatitis B and C, but also for HIV through rapid tests offered in mobile devices.
Furthermore, potential hepatic comorbidities are diagnosed through a FibroScan®, which determines the health of the liver. In case of positive test results, treatment can be initiated immediately. Furthermore, people who are using drugs are educated on transmission risks and how to prevent them. In case they are not immunised against viral hepatitis B, vaccination will be offered.
Preliminary results in Limoges region: 518 patients were screened, 154 (30%) were HCV antibodies positive, and 99 were HCV RNA positive (64%), with an indication for treatment. 72 patients (73%) have been treated or are being treated. 19 patients (3,6%) were HBsAg positive. Today we do not have the possibility of HBV vaccination on site but it will be available in the near future.
Learnings / Recommendations
The “all inclusive” approach of offering all relevant tests and treatments not in a traditional hospital but in a location which is designed to serve the needs of people who use drugs, has proved successful in removing access barriers. The cooperation of different experts in health and social care on dedicated days has added to this success.