Addressing the HCV cascade of care in vulnerable populations with poor access to healthcare in Madrid through of a point of care in a one step

Author: Valencia J, Gutiérrez J, Troya J, Cuevas C, Ryan P

Theme: Models of Care Year: 2019

Persons who inject drugs, homeless people, people with alcohol abuse and sex workers are
vulnerable populations that have a high prevalence of active hepatitis C virus (HCV) infection.
Novel testing modalities and approaches is essential to hurdle the gap of unidentified patients with
active infection and to surveillance HCV reinfections.
Active screening for HCV among vulnerable individuals is carried out in in settings where they
congregate through diagnosis in a single step (HCV Xpert) since March 2019.
A van adapted for the project and a car sets out to actively search and HCV/HIV/HBV screening to
identify those with active infection and is performed by a nurse and two educators hired specifically
for this purpose.
Screening is carried out with a rapid test. All positive results are confirmed within minutes using an
on-site PCR (Xpert® HCV Viral Load Fingerstick). For this test, 100μl of fingerstick capillary blood will
be collected by minivette. and results will be returned within 58 minutes.
In the case of a positive HCV or HIV PCR test, the participant is offered the possibility of referral to
hospital on the same day. HCV-infected patients who accept will be taken by car to the Hospital. The
patient is able to take medication from the hospital pharmacy on the same day.
EFFECTIVENESS: This van started its activity in March 2019 and in a moth of activity it has screening
301 vulnerable individuals (40.5% drug users and 60% homeless and migrants). Of these 13.9% have
a positive HCV antibody test and 36.5% of them have an active HCV infection (four reinfections
included). All positive HCV PCR results were delivered and 86% of them were linked to Hospitals.
CONCLUSIONS: Our preliminary results provide evidence suggest that rapid point-of-care tests and a
low-threshold population-based approach for the HCV allows for testing and linkage to care for
difficult-to-reach populations.
Disclosure of interest: This project received funds of Gilead and Abbie.

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