Standard of Care of Hepatitis C in the Addiction Medicine Clinic Centre St-Martin

Author: Sami Krakria, Elena Roger, Claire Élise Burdet, Jérôme Ebiner and Erika Castro, Policlinique d’addictologie Centre St-Martin

Theme: Clinical Research Year: 2015

Background: Centre St-Martin offers integrated psychiatry and internal medicine outpatient services to people who use drugs, as part of a person-centered approach of hard to reach patients. In 2014 onsite liver fibrosis testing was implemented as a standard of care of chronic hepatitis C monitoring. This report discusses the Clinical Research outcomes and pluridisciplinary boundaries of our current standard of care.

Patients and Methods:
Patients are followed by a case manager (nurse or social worker) who is in charge of engaging them to blood screening for HIV and HCV. Recorded outcomes were prevalence of positive anti-HCV antibodies and HCV RNA, liver fibrosis score and rate of antiviral treatment in patients with chronic HCV infection.
Results: Overall 447 patients were on follow-up between Jan-2014 to Mar-2015). The median age was 39 years (range: 20-65), 75% were men, 92% were on opiate substitution treatment, 69% received a social security or disability pension and 17% were homeless. Main comorbidities were: chronic alcoholism: 54%, mental disorders (ICD-10): 52% and HIV-infection: 11%. Prevalence of positive anti-HCV antibodies was 50% (n=223) with 28% (n=125) presenting documented RNA viremia (>15 UI/mL). Liver fibrosis score was assessed in 64 patients, as follows: F3-F4 in 17%, F2 in 16% and F1 in 67% of patients. Median APRI score was 0.6 (range: 0.2-2.8). Genotype (GT) distribution was GT 1: 55%, GT 3: 32% and GT 2-6: 13%. Hepatitis C treatment rate was 6 % vs 3% per year prior to onsite fibroscan facility.
Discussion: Addition of onsite liver fibrosis testing has led to increased awareness concerning chronic hepatitis C related liver disease among health workers and has improved patients’ engagement in the monitoring process. HCV treatment rate was doubled regardless of current restrictions for reimbursement of DAAs by the Swiss health insurances system (limited to ≥ F3 or extra-hepatic manifestations).

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