ID: HR19-1136

Presenting author: Marianne Alanko Blome

Presenting author biography:

Marianne Alanko Blome, MD, Ph.D, is a clinician at the Dept. of Infectious Diseases at the Skåne University Hospital in Malmö. She is the Medical Supervisor of the Malmö NEP and also working at the Regional Office of Communicable Disease Control and Prevention in Skåne County.

PROJECT ACTIONNE: HEPATITIS C TREATMENT AT THE MALMÖ NEEDLE EXCHANGE PROGRAM

Marianne Alanko Blome, Sara Alsterberg, Martin Bråbäck, Anna Jerkeman

Background:
The Malmö NEP (MNEP) was opened in 1987, playing a prominent role for persons who inject drugs (PWID) in the Skåne region in southern Sweden. Despite a very low prevalence and incidence of HIV and a decreasing incidence of hepatitis B due to successful vaccination, the prevalence (60 % anti-HCV positive at NEP enrolment) and incidence of hepatitis C (31/100 person years at risk) has remained high. Improved HCV diagnostics through regular HCV RNA testing and assessment with transient elastography (Fibroscan) on site was introduced in 2016.

Methodology:
In April 2018 Project ACTIONNE was launched: A prospective open label study to evaluate treatment of chronic HCV infection with glecaprevir/pibrentasvir in PWID attending a needle exchange program (n=50). The primary endpoint is sustained virological response at 12 weeks (SVR12) after completion of HCV treatment (8 weeks for F0-3 or 12 weeks for F4). Secondary endpoints are: 1. Number of re-infections/relapses, 2. Completion rate, 3. Adherence to treatment, 4. Virological resistance patterns, 5. Effects on health related quality of life and risk behaviour. All steps within the cascade of care will take place at the NEP, including individual assessment by infectious disease and addiction care specialists, aiming at maximizing adherence and minimizing reinfections.

Results:
Inclusion will continue to April 2019. So far, 20/50 (40 %), have been screened, 16 included and 12 have reached end of treatment, all with no detectable viremia at EOT. Presentation of results will include age, gender, subjectively and objectively collected information on substance use during treatment, medical and virological data.

Conclusion:
We hypothesize that a well-functioning NEP, equipped with the right medical resources for HCV treatment, can be used for offering the full cascade of care. This concept is expected to have an impact on both individual and group levels concerning HCV related morbidity and mortality.