Engaging PWID In Community Based Treatment And Care Using A Nurse-Led, Social Network Model

Author: Allardice K, von Bibra S, Doyle JS, Dietze P M, Desmond P, Stoove M, McBryde E, Higgs P Thompson A, Hellard ME

Theme: Models of Care Year: 2018

Significant reductions in future hepatitis C Virus (HCV) infection could be achieved by
delivering treatment in the community to people who currently inject drugs (PWID).
Marginalized PWID may have difficulty accessing mainstream services due to stigma, a lack
of trust, poverty, mental health issues and incarceration. We describe an outreach nurse-led
model (NLM) of HCV treatment used in the Treatment And Prevention (TAP) Study; a trial
measuring the HCV prevention effectiveness of treating PWID and their injecting partners.
Specialist nurses worked out of a mobile van or primary health care service to recruit PWID
and their nominated injecting partners into the study. This model facilitated rapport and trust
building through regular contacts and a consistent field presence. This proved important for
treatment retention and for measuring follow up outcomes. Nurses provided private, nonjudgmental HCV testing and treatment, fibrosis assessment using FibroScan and harm
reduction advice.
Three hundred and forty four PWID and their injecting partners were screened over a threeyear timeframe. Of these 225 were randomised, 100 have received treatment to date and 62
have successfully completed beyond SVR12 to the final week 84 of the study. Quality of life
measures post-treatment are yet to be assessed, however many of the treated PWID have
reported an improved sense of wellbeing. The support of fieldworkers, peers, local
government, agencies and police has been imperative to the success of this model.
Despite many obstacles to the delivery of HCV treatment to this population our NLM
provided a viable platform on which to build future models of care. Flexibility when
scheduling appointments, timely access to reflexive testing and treatment and a consistent
field presence are needed. The TAP study demonstrates the feasibility of outreach and
community-based NLMs for engaging and treating PWID living with HCV.
Disclosure of Interest Statement:
The TAP Study is an Investigator-initiated study supported by a research grant form Gilead

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