From HCV Diagnosis to Treatment Initiation in Drug Users: Results From a Mobile Outreach Program in Lisbon

Author: Claudia Pereira Diogo Morais Filipa Barata Hugo Faria Linda Gonçalves Carolina Marquez Rodrigo Coutinho

Theme: Models of Care Year: 2022

Background: Infectious diseases are a leading cause of death and disability in some vulnerable
populations, such as drug users and the homeless. Harm reduction programs undertake a
significant effort to screen, diagnose and treat these burdensome conditions. Infectious
diseases were always a priority in the Mobile Outreach Program (MOP) managed by Ares do
Pinhal in Lisbon (Portugal) since the beginning of the millennium.
Description of model of care/intervention: All the users provided written signed informed
consent forms, authorizing access to epidemiological data and substance use records.
Screening for ID as part of the routine practice at the MOP.
Effectiveness: In the last six years, we developed three different strategies to address the
needs of the patients that were positive for AbHCV: 1) From June 2015-October 2017 we
referred patients to hepatology appointments on their own; 2) From October 2017-March
2019 our team took the patients directly to the hospital by car to attend clinical appointments
and exams; 3) From February 2020 onwards, the hepatologist goes to the mobile unit and the
patient is not required to go to the hospital. In all these approaches, if treatment is prescribed,
the medication is taken while doing methadone daily at the MOP.
Since the 2017 study, from the 307 RNA positive results, 70 patients concluded HCV treatment
with an average mean time between diagnosis and the beginning of treatment of 41 months.
Conclusion and next steps: Time from diagnosis to treatment initiation remains very high.
However, more than clinical uncertainty, drop-outs, failure to follow on referral to clinical
appointments, and the COVID pandemic all contributed decisively to the increase in time to
treatment initiation. Further efforts must be pursued to ensure that in the coming years, this
issue is addressed, since early diagnosis and treatment initiation is a condition for better
clinical prognosis.
Disclosure of Interest Statement:
The authors have no conflicts to declare.

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