André-Jean REMY (1,2), Hugues WENGER (1),Hakim BOUCKHIRA (1), Stéphane MONTABONE (1),

Agnès SENEZERGUES (2)(1) Hepatitis Mobile Team, Service of Gastroentrology,

(2)Consultation Unit and Ambulatory Care, Perpignan Hospital, FranceAndre.remy@ch-perpignan.fr

News Tools of screening viral hepatitis in real life: the french model of care

HEPATITIS MOBILE TEAM

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EXPERT GROUP INSERM 2010INFECTIOUS RISK REDUCTION AMONG DRUGS USERS (DU)

Recommandations :

• 1) Screening ALL drug users for HIV and hepatitis B and C, and also screening again at least once a year

• 2) Evaluating impact of advanced hepatology and infectious diseases consultations : in high and low levels methadon centers (CSAPA/CAARUD) and inmates medical unit (UCSA) and other potential places

• 3) Being close to DU in high and low levels methadon centers (CSAPA / CAARUD) because it appears an improvement factor for viral hepatitis diagnostic and treatment

• 4) Promoting access for DU to psycho-educative intervention programs outside of hospital

• 5) Establishing multidisciplinary outreach centers "all in one" screening to treatment, including vaccination against HBV, provide medical care and also social care

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HEPATITIS MOBILE TEAM

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10 SERVICES « à la carte »1. Screening / Point of Care Testing POCT (HIV HBV

HCV) 2. Mobile liver stiffness Fibroscan* (indirect

measurementof liver fibrosis) in site3. Social screening and diagnosis (EPICES score)4. Advanced on-site specialist consultation5. Easy access to pre-treatment commissions

(“RCP”) with hepatologists, nurse, pharmacist, social worker, GP, psychiatric and/or addictologist..

6. Individual psycho-educative intervention sessions

7. Collective educative workshops 8. Staff training9. Drug users information and prevention10. Green thread: special outside POCT and

FIBROSCAN*

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IntroductionHepatitis B and C screening was

usually done by serology in laboratories or medical centers

If serology was positive, viral load and genotype was determined

patient saw hepatologist if viral load was also positive

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Introduction (2)Liver fibrosis was measured after first

medical consultationAll steps took 3 to 6 monthsDrug injection was main contamination

route of hepatitis C virus (HCV) in France and western Europe since 1990

highest european screening rate in France still 33% of patients didn’t take care of hepatitis C

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Methods (1)Hepatitis mobile team proposed new

model of screening high risk patients for hepatitis C or B

All team members (nurses and social worker) came together in outreach centers, jailhouses, drug services centers and all structures which care drugs users, homeless or other precarious patients

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Methods (2)triple screening in same time:

social screening with specific score of 11 questions called EPICES

POCT for HCV HBV and HIVliver fibrosis screening by FIBROSCAN*

With this results, patient could do his/her biology quickly and see hepatologist in 2 or 3 weeks only

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PARTNERS ORGANIZATIONS

HEPATITIS MOBILE TEAM

Associative sector

Patients associationPsychoeducative networkHepatitis network

Hospital services

• Asyleum medical unit• Jailhouse medical unit• Primary care access unit• TB unit• Addictology service• Gastroenterology service• Medical duty home

Psychiatric Hospital

• One Day hospital and Psychiatric Mobile Team

• Mao – psychiaitric diagnosis and orientation module

Outside hospital

• Methadon centers• Low threesold drug center• Housing units• Therapeutic Coordination

Apartment• Day reception and home

association 9

500 000peoplearea

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Workplaces of HMTDrug centers JailhouseDay reception home unitPrimary care acess unitSpecific converted truck

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Point Of Care TestingPOCT HCV / HIV / HBV

Alternative to blood test, but in case of positive test a blood test confirmation is necessary

Quick on digital puncture

Immediate results

Free, renewal of HCV/ HIV status as soon as necessary

Reliable 3 months after taking HIV / HCV / HBV risk Do not detect the primary infection

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Results (1)1101 POCT were done in 24

months12% were positive for HCV22% were positive for already

known patients who returned to medical care by this pathway

7% positive for HBV1 POCT was positive for HIV

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Fibroscan*

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Results (2)393 FIBROSCAN* were done medium rate of 7.8 Kpafibrosis level F268% for HCV3% for HBV29% for alcoholic liver disease

 

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Results (3)All patients were evaluated with specific

social score EPICES (since september 2014)

11 questions yes/noMaximal score 100> 45.8 = precarious patients90% of our patients were precarious… 98 patients in 9 months311 interviewsAverage 3 per patientMaximum 15 interviews for one!

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Results (4)190 patients were followed by nurses

and social worker134 patients were addressed to on

site hepatologist consultations 112 came at least once

45% of patients were treated by DAAonly 3% were lost sight

 

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Patients’ wordsFree accessCloseness (outside hopital)Speed (of the results)Availibility (of nurse and social workers)

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A new clinical patient pathway?Free services for outpatients with or

without social insuranceScreening (POCT / FIBROSCAN*)Diagnosis (biology)Treatment (RCP)HCV cure

New referral pathways Possible by specific trained nurses

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Conclusiona new model of carebased on site triple screening (serology, liver fibrosis, social diagnosis) and follow up

increased number of patients diagnosed, treated and cured

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We need to provide

servicesthat meet the needsof high risk groups

2020

THANK YOU FOR YOUR ATTENTION!

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Any questions ?

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