Peer support in small towns: A decentralized mobile Hepatitis C virus clinic for people who inject drugs.

Autor: Midgard H; Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway.; Department of Gastroenterology, Oslo University Hospital, Oslo, Norway., Bjørnestad R; ProLAR Nett, Søgne, Norway., Egeland M; ProLAR Nett, Søgne, Norway., Dahl E; ProLAR Nett, Søgne, Norway., Finbråten AK; Unger-Vetlesen Institute, Lovisenberg Diaconal Hospital, Oslo, Norway., Kielland KB; Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway., Blindheim M; The Norwegian Directorate of Health, Oslo, Norway., Dalgard O; Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway.; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Jazyk: angličtina
Zdroj: Liver international : official journal of the International Association for the Study of the Liver [Liver Int] 2022 Jun; Vol. 42 (6), pp. 1268-1277. Date of Electronic Publication: 2022 Apr 12.
DOI: 10.1111/liv.15266
Abstrakt: 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.
(© 2022 The Authors. Liver International published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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