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André-Jean REMY

André-Jean REMY

Perpignan Hospital, France

Title: Access time to antiviral c treatment is equal for very fragile drug users and inmates, longer for drug centers patients: interest in having a dedicated multidisciplinary team

Biography

Biography: André-Jean REMY

Abstract

In hepatitis C, Drug users and inmates are a hard to screen population as well as to take over and treat. There is a common understanding that these patients have a delayed access to antiviral C treatment. French rulings published on June 10, 2016 could provide treatment by direct acting antivirals (DAA) to all these patients regardless of fibrosis stage. Since it’s creation in July 2013, the hepatitis mobile teams offers to all partner entities all or part of the following 15 services: 1. Training of socio-medical institutions staff with trimestral  days of exchange or on-demand and on-premises. 2. Prevention information sessions toward drug users in day-care or housing structures. 3. On-site HVC HVB HIV POCT screening. 4. BOUSSOLE 5 days a week Reception Information & Accompaniment. 5. On-premises mobile Fibroscan®. 6. Social evaluation & diagnosis by EPICES score. 7. Free biological check-up at the PASS (in case of absence of health care rights). 8. On-site specialised consultations. 9. LE FIL VERT: POCT & Fibroscan® in outdoor sites. 10. Rapid access to a close expert service called “RCP” (multidisciplinary meeting), obligatory in France before treatment acesss. 11. Mobile phone lending for patients. 12. Individual sessions of therapeutic education inside an ARS (Regional Health Agency) authorized program. 13. Therapeutic support groups (nurse, psychologist, sophrologist, nutritionist). 14.  Dedicated day hospital. 15. Expert patient support.

 

Patients and methods: The aim is to compare the average delay of access to DAA treatment in 2016 of all the patients of our centre (group 1) to the drug user patients (group 2) followed by specialised medico-social institutions (CSAPA/CAARUD), to excluded patients newly outdoor screened (group 3) with an EPICES score over 45 and inmates (group 4). The date of first contact was when the patient met the hepatitis mobile team nurse in CSAPA/CAARUD, screening date for the outdoor patients and date of detention for inmates. Was also calculated the average delay of access to RCP and the one between RCP and treatment day 0. Groups 3 and 4 patients were totally taken over by the hepatitis mobile team.

Results: 113 patients were included in this study on September 15, 2016. Average delay between first contact and treatment day 0 was of 10 weeks with differences among groups detailed in Table 1. Average access delay to treatment was of 98 days for group 2, 70 for group 3 and 57 for group 4. Average delay between first contact and RCP was respectively of 56/77/55 and 49 for groups 1 to 4. The difference would be due to average delay between RCP and treatment day 0. The delay difference was significant (p<0,05) between group 2 and 1. No significant difference was stated in groups 3 and 4 against group 1.

Conclusion: Drug users who are followed in a medico-social institution have by our experience a longer access to antiviral C treatment than inmates or excluded patients. This is explained by a shorter care pathway (screening-blood test-RCP-treatment) and calls for an organisation of “all-in-one” centres, set-up around a multidisciplinary team to the benefits of patients with chronic hepatitis C viral infection.

Time (days)

Total of patients

PWID in drug centers

Precarious outdoor screening people

Inmates

First contact to treatment

70

98

70

58

First contact to RCP

56

77

55

49

RCP to treatment

14

19

15

9

Publications:

  1. AJ REMY, H WENGER, H BOUCHKIRA. Traiter l’hépatite C  chez des patients usagers de drogue et/ou précaires : utile, efficace et éthique. Presse Médicale 2014, 1314-1316
  2. REMY AJ, WENGER AJ, BOUCHKIRA H. Treatment of chronic hepatitis C in drug users : ethic, successful and useful. EUROPAD FORUM during AATOD Conference, Atlanta,28 mars-1er avril 2015..
  3. BOUCHKIRA H. Treatment of chronic hepatitis C in drug users : ethic, successful and useful. Viral Hepatitis Congress, Orlando 19-22 juillet 2015.
  4. REMY AJ. News Tools of screening viral hepatitis in real life: the french model of care. Viral Hepatitis Congress, Orlando 19-22 juillet 2015.
  5. REMY AJ. Incidence of the hepatitis C in prison in france: results of a study by POCT. Viral Hepatitis Congress, Chicago 9-11 mai 2016.
  6. REMY AJ. BOUCHKIRA H, MONTABONE S. Dépistage hors les murs de l'hépatite C par TROD: résultats de 3 années de pratiques. Communication orale AFEF Bordeaux 2016.
  7. REMY AJ, BOUCHKIRA H, MONTABONE S. Decrease of specific social score EPICES before and after direct antiviral agent  treatment in HCV patients in France: 2 years experience. Third Hepatitis World Congress, Dubaï, 9-11 octobre 2016.
  8. REMY AJ, BOULOGNE G. COMPASS project, inside and outside link for prisoners and PWID with hepatitis C in France. EUROPAD FORUM during AATOD Conference,  Baltimore, 29 octobre – 2 novembre 2016..
  9. REMY AJ, BOUCHKIRA H, MONTABONE S. Hepatitis Mobile Team: a new concept for benefit toward drugs users and precarious people with hepatitis C in France. AASLD Boston 2016