An innovative peer-based support program, providing a scalable solution for access to HCV screening and treatment for PWID into the public healthcare system in Hanoi, Vietnam

Mathilde Laval, Nguyen Trang, Ernst Wisse, Pham TM

Issue
In Vietnam, People who drugs have very limited access to screening, diagnosis and treatment of HCV. Although some Harm Reduction (HR) services are available, enhanced HR facilities (like Drop-in centers or community spaces) are not available in Hanoi. This severely hampers advance support programs like medical treatment initiation and follow-up.

Médecins du Monde and local partners developed a pilot peer-based intervention as a flexible support program to enable uptake and treatment follow-up of PWID into a district level health center (DHC), hereby enhancing the HCV cascade of care; raising awareness, screening & diagnosis referral, uptake & completion of treatment for PWIDs.

Setting
An estimated 200,000 PWUD in Hanoi, HCV prevalence rate estimated as high as 97.2%.

Project
A team of peer workers were trained to integrate HCV sensitization in their existing outreach work and raise awareness and interest in testing and treatment. After a pro-active initial screening and pre-counseling by peer workers, PWID were accompanied by a peer to the DHC. Medical staff were trained on HCV care and counseling. With HepC as the entry point, PWID were as well accompanied to other services available at the DHC: OST, ART, TB treatment...

Outcomes
This low-cost model has shown very good results: 100% beneficiaries received counselling and fibrosis assessment, high rates of HBV vaccination completion, a cohort of 106 PWIDs is finishing HCV treatment with only 1 patient lost to follow-up. This flexible model operates as an independent program supporting the existing healthcare system.

An in-depth capitalization of this intervention is underway to provide hands-on guidance to stakeholders, in particular community-based, willing to implement, scale-up or replicate a similar affordable intervention – the results will also contribute to framing advocacy messages to push for much needed consideration of the HCV epidemic among PWID by the Vietnamese government.