Course of Care for Hepatitis C in Users of Psycho-active Substances According to the Addictological System of Care and Place of the Test and Treat Strategy

Abstract

Aim: The treatment of addiction is well structured in France, with different care and prevention services available, such as addiction treatment and prevention centers, the network of medical microstructures centred on general practitioners, and lower risk consumption rooms. The objectives of our study were to compare the courses of care for hepatitis C provided within one addictology center offering all three of these services, as well as to clarify the role and factors associated with the test and treat strategy. Methods: 573 users were included prospectively from all three of the above-mentioned services: 168 from the addiction treatment and prevention center, 291 from the network of medical microstructures and 114 from the lower risk consumption room. They were consumers of one or several psycho-active substances (illegal substances, alcohol, tobacco). The different hepatitis C courses of care were compared between the three services. The test and treat strategy was evaluated in comparison with conventional strategy in all the users. Results: The users were characterized as being predominantly male (65.4%), with high occurrence of polydrug use (61.2%) and low socioeconomic status (complementary health solidarity 43.8%, precarious housing or homelessness 23.9%, living alone 47.1% and lack of paid employment 72.9%). The course of care for hepatitis C did not differ significantly between the three services: screening performed for 90% with HCV RNA detected in 100% of users, access to treatment varied from 61 to 100%; hepatitis C was cured in all users. The test and treat strategy was used in the majority of cases, particularly those treated at lower risk consumption room (93.8%). This strategy was associated with type of consumption and low socioeconomic status (p <0.001). It also correlated with easier and faster access to antiviral treatment (80.6%) compared to the conventional strategy (45.4%, p <0.05). Conclusions: This study confirms the benefit of using the test and treat strategy for fast treatment of hepatitis C in psycho-active drug users leading to consistent cure and the emergence of a new strategy named “test and cure”.