Viral Hepatitis

Biography

Biography: Remy Andre-Jean

Abstract

Introduction: Although highest European screening rate is in France, 44% of patients are not aware of hepatitis C because they were not diagnosed. Drug injection was main contamination route of hepatitis C virus (HCV) in France and Western Europe since 1990. French guidelines were to treat all inmates and drug users, even fibrosis level. Access of HCV screening, care and treatment in drugs users, prisoners and homeless was low in France, less than 20% and 33% of HCV patients were under diagnosed. They were considered as difficult to treat populations. All these patients need support especially psycho-educative interventions. Hepatitis Mobile Team (HMT) was created in July 2013 to increase screening care and treatment of hepatitis B and C patients. We proposed 15 services: 1. Screening by Dried Blood Spot (DBS) HIV HBV HCV 2. Mobile Fibroscan in different sites 3. Social screening and diagnosis (EPICES score) 4. Outreach center with specific health care workers 5 days/7 5. Free blood tests in primary care if no social insurance 6. Advanced on-site specialist consultation 7. Access to obligatory pre-treatment commissions. 8. Individual psycho-educative sessions 9. Collective educative workshops 10. Staff training 11. Drug users prevention 12. Peer to peer program 13.Low cost specific patients mobile phones 14.Specific one day hospitalizations before and after antiviral treatment 15. Green thread: outside DBS and FIBROSCAN* in specific converted truck.

Objective: Increase screening care treatment access and cure for target population.

Patients & Methods: Target population was drugs users, prisoners, homeless, precarious people, migrants and psychiatric patients. We proposed part or all of our services to our medical and social partners. They choose only services what they need.

Results: From 2013 July to 2015 December, we did 2056 DBS for 1485 people (944 HCV DBS). Our HCV active file was 244 patients, 18% of new patients screened by DBS; 83% realized all blood tests and FibroScan; 59% need treatment according to French recommendations; 50% started treatment and 49% have been cured. Quality of program for patient were free access, closeness (outside hospital), speed (of the results) and availability (of nurse and social workers).

Conclusions: Specific screening, follow up and support of these difficult to treat populations are essential for increase medical management and cure of HCV patients. HMT offered complement services and not substitution of existing services. It was new useful tool to screen, diagnose and treat these patients by outside pathway of care. French Health Ministry announces treatment for all HCV patients in June 2016 and HMT was a cost efficient program to treat every patient.