Linking PWUD, People Who Use Drugs, Into Hepatitis C Care

Author: Jean Robert, Julie Tremblay, Hugo Bissonnet, Tara Zeagman, Eric Latour

Theme: Epidemiology & Public Health Research Year: 2017

In Quebec, 63% of HCV (hepatitis C virus) cases are among PWUD. Access to testing and care is particularly difficult because of the different stigmas against this population. In 2014, 14.8% of PWUD had access to a treatment.
Between 2014 and 2016, we reached PWUD by 1: offering HCV-HIV-STBBI education and testing activities in rehabilitation centers. 2: promoting word of mouth from patient-to-patient. Tests were free, anonymous, included all STIBBI and free vaccination. HCV patients were linked whether they had Medicare or not and engaged in weekly treatment with holistic care and a harm reduction approaches. The data analyzed comes from 822 PWUD that were reached out from rehab centers and another 172 PWUD who followed the HCV treatment.
Most referrals were from patient-to-patient (28%) or from rehab centers (45%). Tests showed no immunity to VHA (62%) and VHB (33%) despite a free national vaccination program. HCV prevalence in rehabilitation center was of 5.2%. All HVC PWUD engaged in treatment they had if access to it; 18% had never been offered a treatment in the past. 86% of patients who did a treatment were cured from HCV. Only 5% did not complete the whole treatment and 5% did not show up for a final assessment once the treatment was completed. 90% of patients remain linked to the clinic 6 months after completing treatment. Only 3 reinfections occurred.
In a welcoming and flexible environment, PWUD engage easily in care and are observant. PWUD are an effective means to reach out to others. Rehabilitation centers provide an easy access to a renewable pool of people infected or at risk. Of all PWUD living with HCV, 37% did not meet treatment reimbursement standards. HCV education and prevention reduced reinfection even with DAA. Therefore, treatment should available to all PWUD.

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