Treating people in COVID 19 sheltering sites: Nurse-led hepatitis C (HCV) micro-elimination project during dual public health emergencies for people who inject drugs (PWID) in Victoria, Canada

Author: Tamara Barnett Karen Lundgren Kellie Guarasci Christiane Gray-Schleihauf Hannah Roy Marion Selfridge Chris Fraser

Theme: Models of Care Year: 2021

Background: The dual public health emergencies, COVID 19 and the overdose crisis, prompted the Province of British Columbia to enact a public safety order to move the hardest to house individuals living with chronic mental health challenges and problematic substance use into hotels. The aim was to prevent COVID spread and provide safer pharmaceutical alternatives to illicit street drugs. These settings provided a critical opportunity for the implementation of an HCV micro-elimination; ‘seek and treat’ model of care within the Cool Aid onsite clinics. Many of the clients had limited primary care involvement which presented a unique opportunity to engage and link to HCV care. Description of model of care/intervention: This nurse-led project occurred in COVID protocol compliant, hotel sheltering environments. Our successful HCV test and treat model collaborated with other agencies in this novel treatment setting. HCV treatment education was provided for peer harm reduction partners, which led to broader HCV treatment awareness and increased overall treatment uptake. Onsite primary care nurses screened using OraQuick/bloodwork. Clients unable to access the hotel medical clinic were screened in their rooms. Medications were provided as daily witnessed ingestion (DWI) and delivered directly to clients’ rooms. Individualized treatment plans and daily case management increased medication adherence and engagement in primary care. Effectiveness: 400 individuals moved into these hotels. Currently, 84 HCV RNA positive, 40 have completed treatment (12 have sustained virological response), 20 on treatment, 2 died, 22 untreated. Conclusion: This novel model of care has dramatically decreased the local burden of HCV in PWID during dual public health emergencies and can be used as a model of care for other nurses and communities. Disclosure of Interest Statement: CACHC is part of the Victoria Cool Aid Society, a non-profit organization. We receive support for our health programing from AbbVie Corporation and Gilead Sciences.

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