ID: HR19-547

Presenting author: Flavie OSTER

Presenting author biography:

Dr. Flavie Oster, medical director of ITHAQUE, has been working in the addiction field for almost 10 years. Her involvement with users encourages her to explore the most innovative practices to improve the care supply for the most vulnerable patients.

Towards a "test and cure" strategy for drug users (DU) in a French drug consumption room (DCR).

Fiorant DI NINO, Flavie OSTER, Gauthier Waeckerlé, Frédéric Chaffraix, Michel Doffoel

Introduction

The DCR, is open to DUs marginalized and break with existing reception and care facilities. The concept of the "test and treat" in HIV infection is transferable to hepatitis C in "difficult" populations, especially as in hepatitis C, DAAs allow a real cure. Thus a "test and cure" strategy could be applied to optimize the care path, shortening as much as possible the delay between the screening and the treatment of hepatitis C. The arrival of the HCV rapid screening test and soon rapid quantification tests HCV-RNA will make this new strategy possible.
The purpose of this study is to evaluate the feasibility of combining rapid bioassays and FibroScan® in the screening and diagnosis of hepatitis C in DCR prior to initiation of DAA therapy.

Patients and methods
A 10-day study, involved 44 DUs of the DCR. A rapid screening test for HCV was first proposed. It was immediately followed by a FibroScan® (mobile device). In case of positivity, a rapid RNA quantification test by capillary blood (Xpert HCV VL Fingerstick®) with a result in 58 min was proposed. DAA treatments was then discussed after an announcement of the disease in an interview with the health care team.

Results
Of the 44 HCV rapid screening test proposed, 34 were accepted (77.3%) and 11 were positive (32.3%). HCV-RNA was investigated in 10 seropositive DUs (91%). It was positive for 5 of them (50%) allowing a quick and unambiguous announcement of the disease by the team. The 5 DUs accepted the treatment that was started after a few days in 3 of them. The other 2 DUs did not have open social rights.

Conclusions
It suggests that a "test and cure" strategy in hepatitis C is applicable in DCR, subject to anticipating the opening of social rights.