Tools of Screening Viral Hepatitis B or C in Real Life: New French Model of Care

Author: Andre Jean REMY, Hakim Bouchkira, Hugues Wenger, Stéphane Montabone

Theme: Epidemiology & Public Health Research Year: 2015

Introduction: Viral hepatitis screening was usually done by serology in laboratories. If serology was positive, viral load and genotype was determined and after that patient saw hepatologist if viral load was also positive. Liver fibrosis was usually measured after first medical consultation. All steps took 3 to 6 months. Although highest european screening rate, 44% of patients were no diagnosed. Methods: Hepatitis Mobile Team (HMT) proposed 10 services to patients and partners: 1/ Point of Care Testing POCT 2/ Mobile liver stiffness Fibroscan* 3/ Social screening and diagnosis 4/ Advanced on-site specialist consultation 5/ Easy access to compulsory pre-treatment commissions 6/ Individual psycho-educative intervention sessions 7/ Collective educative workshops 8/ Staff training 9/ Drug users information 10/ Outside POCT and FIBROSCAN* with specific converted truck. Nurses and social worker came together in outreach centers, jailhouses, drug services centers and homeless services for same time triple screening: social screening with specific score, POCT for HCV HBV HIV and liver fibrosis screening by FIBROSCAN*. With results of triple screening, patient could do biology quickly and see hepatologist in 2 weeks only. Results: 711 POCT were done in 12 months; 19 HCV positive for new patients and 69 positive for already known patients who returned to medical care by this pathway. One POCT was positive for HIV and 12 for HBV ; 393 FIBROSCAN* were done with medium rate of 7.8 KPa. Social screening showed 91% of precarious patients. 134 patients were addressed on site hepatologist consultations and 112 came almost one time. 45% of patients were treated with new direct antiviral agents; only 3% were lost sight. Follow up showed one relapser for 41 finished treatments. Conclusions: in our new model of care, triple screening by mobile services and follow up was successful to increase number of patients diagnosed, treated and cured.

Download abstract