Author: Alessia Bassi, Mirko Santi, Cristina Stanic, Ivo Maria Crosato, Flora Masutti, Saveria Lory Crocè, Ariadna Celeste Baez, Roberta Balestra, Paolo Bernardis

Theme: Models of Care Year: 2019

Background: Italian reports show an increase of the users in Addiction Treatment Services (SerD) not
tested for Human Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV). People who inject drugs
(PWID) are the target with the highest prevalence of HCV (30%-60%), but still have reduced access to
directly acting antivirals (DAA), due to lack of information, distrust in Health Services and in
fragmented care programs. Specific skills are needed to establish a trust relationship with these
patients and to promote motivation and collaboration. In this sense, SerD operators play a
fundamental role.
Description of model of care/intervention: Our SerD introduced a novel 5-steps HCV Clinical
Program composed by: (1) Universal screening of PWID, informative counseling and harm reduction
in which the central role is played by the nurse; (2) HCV-RNA positive (HCV+) people are visited by
the hospital specialist, who decides on drug therapy and monitoring. (3) Patients referred to the
Liver Clinic or the Infective Disease Department; (4) People with a more severe addiction and with
psychiatric comorbidity are accompanied by SerD staff to hospital appointments. To prevent drop
outs, DAA therapy is managed differently depending on the personal degree of autonomy (Daily
Observed Therapy); (5) Finally, to prevent reinfections, the follow-up is carried out in close
collaboration between SerD and Hospital.
Effectiveness: Our novel Clinical Program produced an increase of HCV+ people treated with the
DAA therapies. In 2015 and 2016 PWID patients treated were 7.3% (24 subjects), in 2017 they were
35.93% (96 subjects), in 2018 they were 86.58% (111 subjects). All treatments have been completed.
Conclusion and next steps: The integration between SerD and hospital specialists has made it
possible to significantly increase the number of PWID subjects diagnosed, treated and subjected to
informative counseling and harm reduction, to prevent the virus transmission and reinfection.
Disclosure of Interest Statement: Alessia Bassi has received consultancy fees from Gilead. The
project “Dipartimento delle Dipendenze di Trieste: Sperimentazione di un Modello Organizzativo
Integrato Ospedale-Territorio per la Prevenzione, Il Monitoraggio e la Cura di Pazienti con
Dipendenza ed Epatite da HCV” has been partly founded by Gilead