Theme: Models of Care Year: 2021
Background: Despite that DAA therapy is effective, people who use drugs, experience homelessness and migrants have lower HCV treatment uptake and post-treatment follow-up. This study evaluated a model of point-of-care HCV antibody testing combined with nursing and peer-based outreach for vulnerable groups in Lisbon, Portugal, specifically people who use drugs, experience homelessness and migrants. Description of model of care/intervention: CRESCER is a non-governmental organization with 20 years of experience working with vulnerable groups in outreach settings, providing harm reduction and other services for approximately 2,000 people per year, including 500 with recent injecting drug use. CRESCER has developed a model of care consisting of point-ofcare HCV antibody testing combined with nursing and peer-based outreach to enhance HCV testing and treatment among vulnerable groups. Effectiveness: Between October 2018 and March 2020, 133 participants were enrolled (mean age 44 years, 83% male, 83% Portuguese). Overall, 70% reported ever experiencing homelessness, 46% recent (past three months) injecting drug use, 48% ever sharing injecting equipment, 50% had unprotected sex in the last year, and 35% had not engaged in any health services. Overall, 38% (50 of 133) were HCV antibody positive (76% among people with recent injecting drug use) and referred for specialist assessment. Overall, only 30% (15 of 50) attended a specialist appointment. Among the 10 people with detectable HCV RNA, 40% (n=4) initiated treatment. Conclusion and next steps: Despite the high prevalence of HCV infection, there are considerable barriers for attending specialistbased appointments in hospitals for this marginalized population which has led to suboptimal uptake of HCV therapy. To overcome these barriers, CRESCER implemented in December 2020 an outreach intervention integrating nurse-led point-of-care HCV antibody and RNA testing, telemedicine appointments, financial incentives, and peer-navigation. Preliminary results point to an increase in HCV testing and treatment. Disclosure of Interest Statement: See example below: CRESCER has received funding from Portugal 2020 and AbbVie Portugal. JG has received funding from AbbVie, Cepheid, Gilead, Hologic, Indivior, and Merck.
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