HCV antibody and RNA testing combined with nursing and peer-based outreach to enhance HCV testing and treatment among vulnerable groups

Background

CRESCER is a non-governmental organization with 21 years of experience working with vulnerable groups in outreach settings, providing harm reduction and other services for approximately 2,000 people per year, including 400 with recent injecting drug use. Throughout the years of on the field intervention with the outreach teams, one of the identified concerns has been the high prevalence of contagious infectious diseases, especially among PWUD (people who use drugs). Therefore, CRESCER has developed a model of care consisting of point-of-care HCV antibody and RNA testing combined with nursing and peer-based outreach to enhance HCV testing and treatment among vulnerable groups. 

Methods

Model of care consist in an outreach intervention integrating nurse and peer-led decentralised point-of-care for HCV antibody and RNA testing, telemedicine appointments, financial incentives, and peer-navigation. 1)Meeting people in their own environment; 2) Testing people who refuse to leave their circuits to access care and are not linked to any other service; 3) guarantee treatment uptake and post-treatment follow-up. This proximity approach is focused in reach PWUD, who are in an extreme vulnerable situation promoting safer consumption practices and the adherence to health and social services. 

Results

Overall, 568 participants were enrolled (control, n=133; intervention, n=568). In the standard of care arm, 38% (50 of 133) were HCV antibody positive. Among those referred for hospital-based specialist care (n=50), 30% (15 of 50) attended their initial appointment. Among the 10 people with detectable HCV RNA, 4 (40%) initiated and completed treatment. In the intervention arm, 25% (142 of 568) were HCV antibody positive. Among the 46 people with detectable HCV RNA, 80,4% (n=37) attended their initial appointment, 86% (31) initiated and completed treatment, 62,1% (n=23) present undetectable HCV viral load after 12 weeks. 7 still waiting for follow-up. Five people (13,8%) are waiting for treatment. Other important results:  32% adhere to shelter, 5% rent a room, 24% adhere to Housing First program and 16% applied for job offer.

Conclusions 

Decentralisation of care, financial incentives combined with outreach work is an approach that overcomes barriers for vulnerable groups, reduce the stigma and promote their inclusion into social and health structures and citizenship services.