Theme: Models of Care Year: 2018
Background:
The prevalence of HCV infection among people who use drugs (PWUD) in Canada is about
70%, the highest prevalence among any risk group in the country. However, PWUD are also
broadly disengaged from healthcare services. Traditional healthcare models in which
patients to present to care and initiate testing of their own accord will likely not be effective in
this population. We must develop outreach models to identify these individuals in the
community and actively engage them in care.
Description of model of care/intervention:
Our centre has developed the community pop-up clinic (CPC), in which point-of-care HCV
antibody testing is provided at community-based sites where PWUD obtain services such as
emergency lodging, food and rehabilitation consultations. Once an individual is identified as
infected with HCV, an effort at immediate and durable engagement in care is undertaken,
with the goal of providing HCV therapy and follow-up post-treatment to establish treatment
outcome.
Effectiveness:
Between Aug-16/17, we performed 1283 tests. The mean age was 49, 906 were male, 435
were indigenous, 354 were homeless, and 273 were HCV+. Of 208 who were immediately
consulted into care, 83 have been effectively linked to care at our centre in the short term. Of
those, 51 have been initiated on HCV treatment, 30 have achieved the SVR time-point, and
28 of those have been cured of their HCV. This equates to 1 person per week who was
otherwise disengaged from medical care now being initiated on treatment with a cure rate of
93%. A simple 3 hour/week intervention will potentially yield up to 4 new HCV treatment
starts/CPC in patients who would otherwise remain disengaged from care.
Conclusion and next steps:
Novel models of care to identify and link individuals to care will be necessary to meet the
needs of the broadly disengaged population of PWUD. Approaches such as the CPC will be
needed to achieve the WHO goal HCV elimination.
Disclosures:
AA– Travel grants from AbbVie and Merck & Co.
JH – Nothing to declare
DT – Honoraria from Merck & Co.
BC – Grants, honoraria, travel funding, and advisory board positions with AbbVie, Merck &
Co, Gilead Sciences, and ViiV.