Decentralized consultation for infectious diseases with at-risk populations: preliminary results

Background

Infectious diseases (IDs) are a serious public health concern for drug users. Harm reduction programs ensure proper and timely screening, diagnosis, and treatment of these burdensome conditions. The Mobile Outreach Program (MOP) managed by Ares do Pinhal (AdP) in Lisbon (Portugal) has identified this as a priority for over 20 years of working with drug users. Increasing the number of screenings and diagnosis -namely for TB, HIV, HBV, and HCV-, patient education for harm reduction concerning infectious diseases and drug use (to prevent new infections/reinfections), as well as fighting stigma and myths about treatment, is essential to improve clinical outcomes. Concomitant management at the MOP of a methadone substitution program and treatment for infectious diseases, based on a direct observation treatment (DOT), characterize the program. Moreover, referral for specialized consultations is critical to ensure proper management of these patients.

Methods

The present data are based on the medical charts available at the program since the inception of the decentralized consultation (March 2023 – 10 months). This consultation resulted from a formal partnership with Centro Hospitalar Universitário Lisboa Central (CHLC) which provides gastroenterology consultations for the users followed at the MOP managed by AdP. All users provided their written informed consent to access.

Results

A sample of 353 users were screened for IDs in the study period. Most of the sample were males (90%), averaging 41 years old. As for country of origin, 53% were from Portugal, 39% were Asian migrants (mostly from India and Nepal), 3% were from Eastern Europe and 5% were from other European countries. Fifty-seven percent (57%) presented HCV Ab+, of which 38% had active disease -confirmed by Cepheid, GenExepert. Half of these patients initiated therapy, 15 were awaiting treatment and 23 were pending blood collection to be delivered to the hospital to receive treatment approval and initiate treatment. 

Conclusion

Contrary to previous years, these results highlight a shift in the target population, with a noticeable increase in the migrant population due to a migrant inflow to Lisbon. This younger migrant population has a fragile working status, housing issues, and socioeconomic limitations, which become more apparent as the standard of living in Lisbon increases. The MOP’s intervention became more complex since MOP workers had to deal with language and cultural barriers. This highlights the need for swift and constant adaptation and a more effective and inclusive intervention adjusted to the new user profile. Decentralized consultation is key to improving treatment adherence and resulting clinical outcomes in IDs in this at-risk population, and these preliminary results showcase the potential of these partnerships.