Mobile Van Outreach for Primary Care and Hepatitis C Treatment for People Who Use Drugs in Victoria, British Columbia

Author: Marion Selfridge, Tamara Barnett, Fiona Boothman, Anne Drost, Kellie Guarasci, Karen Lundgren, Tamara Barnett, Chris Fraser

Theme: Models of Care Year: 2023

Background: People who use drugs (PWUD), account for the majority of new hepatitis C (HCV) cases and continue to have barriers to accessing DAA therapies, despite demonstrated high SVR rates in clinical trials. Mobile outreach vans have been shown to facilitate access to HCV testing and treatment.

Description of model of care: The mobile outreach van, staffed by physicians, nurses and health outreach worker provides primary care, including Opioid Agonist Treatment starts and follow up, wound care, STI testing and treatment, reproductive health, mental health support, advocacy and referrals to social supports, harm reduction supplies including naloxone, supplements, and snacks. The mobile van travels to supportive housing sites, shelters, and local support services such as food banks that support PWUD. It offers on site phlebotomy – testing and treatment for HCV is included in general screening bloodwork for all clients and supports peer HCV testing events.

Effectiveness: In 2022, physicians and nurses had over 2,700 encounters with people accessing the van.
Our Nurse-led HCV program has provided support in starting clients on HCV treatment through the van. The mobile outreach team provides pre-treatment counselling, bloodwork, weekly medication delivery and monitoring with ease from the van. Nineteen HCV treatments have been started from van (11 SVR) to date. Building strong relationships with housing staff across the sites has provided opportunities for partners to learn more about simplified testing, limited side effects and shortened time of DAA treatments. These relationships with housing staff, and ‘word of mouth’ from peers help reduce stigma associated with HCV and increase treatment uptake.

Conclusion and next steps: By providing HCV treatment to clients in their homes and communities, our team removed barriers PWUD face accessing health care, where they had no GP, using emergency rooms for all care, experiencing stigma and shame around substance use.

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