20 Years Of Evolution Of The Comprehensive Model Of Care For PWID To Enhance HCV Treatment Uptake And Outcome

Author: REHAK, V

Theme: Models of Care Year: 2018

Background: More than 20 years ago we noticed an increasing number of HCV cases among PWID in Czech Republic and we aimed to establish an initial scheme for workup and management in this specific population. HCV treatment access and uptake was suboptimal in PWID compared to other patients group. It contrasted with the evidence of high antiviral treatment efficacy in this group even with the traditional interferon based regimens. With the goal to reach drug users and to offer timely and targeted health care services for PWIDs including the personally tailored HCV therapy a Program of Comprehensive Care in Prague has been established. Approach: The basic principles of care: low threshold access to medical services, including basic and specialized health care, blood borne and sexually transmitted diseases testing, pre and post-test counseling as well as harm reduction services such as opiate substitution treatment, psychosocial counseling and crisis intervention, individual and group psychotherapy, etc. All medical and non-medical interventions are concentrated in one location; the program is placed within the premises of outpatient health care center attended also by non-drug users, preventing segregation of patients with “stigmatizing” disease. Outcome: Number of HCV treated patients increased from several tens in 2003 to nearly 700 in 2017. We hope to serve as an example of “good practice” when over the years Remedis became a largest HCV treatment center in the country with no threshold access for PWID. Historically, sustained virological response with peginterferon and ribavirin exceeded 80% regardless of genotype and new generation antivirals can demonstrate efficacy far over 90%. Conclusion: Under-one-roof concept proved to be effective and accessible for PWID. The major next step is to enlarge the engagement in Prison program where the most unmet need for HCV management is apparent. Disclosure of Interest Statement: Nothing to disclose.

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