Theme: Models of Care Year: 2022
Background:
Outreach teams operating in urban areas of Lisbon with high levels of drug consumption need to
overcome barriers to care in marginalized populations of people who use drugs, people who
experience homelessness, and migrants, that may not receive adequate support through the health
system. The REACH_U project aims to evaluate an intervention integrating peer and nurse-led
outreach, incentives, point-of-care HCV antibody, RNA testing, and specialist assessment to increase
treatment uptake.
Description of model of care/intervention:
REACH_U is a historically controlled, before and after, study comparing HCV testing and treatment
uptake during an intervention to decentralize care (n=256, December 2020-February 2022)
compared to standard of care (n=133; October 2018-March 2020). During standard of care, point-ofcare HCV antibody testing was performed, and HCV antibody-positive participants were referred for
hospital-based confirmatory HCV RNA testing and treatment. During the intervention, a specialized
outreach team (peer and nurse) performed HCV antibody and RNA testing (GeneXpert HCV Viral
Load Fingerstick) with referral to decentralized specialist assessment (telemedicine included) and
treatment.
Effectiveness:
Overall, 389 participants were enrolled (control, n=133; intervention, n=256). In the standard of care
arm, 38% (50 of 133) were HCV antibody positive. Among those referred for hospital-based specialist
care (n=50), 30% (15 of 50) attended their initial appointment. Among the 10 people with detectable
HCV RNA, 4 (40%) initiated and completed treatment. In the intervention arm, 31% (79 of 256) were
HCV antibody positive. Among the 31 people with detectable HCV RNA, 90% (n=28) attended their
initial appointment, 14 (50%) initiated and completed treatment, and 14 (50%) are waiting for
treatment.
Conclusion and next steps:
Preliminary results point to an increase in HCV testing and treatment among people who use drugs,
people who experience homelessness, and migrants when decentralized care is implemented.
Disclosure of Interest Statement:
CRESCER has received funding from Portugal 2020 and AbbVie Portugal. JG has received funding
from AbbVie, Cepheid, Gilead, Hologic, Indivior, and Merck.