The Copenhagen test and treat hepatitis C in a mobile clinic study: a protocol for an intervention study to enhance the HCV cascade of care for people who inject drugs (T’N’T HepC)

Abstract

IntroductionInjecting drug use is the primary driver of hepatitis C virus (HCV) infection in Europe. Despite the need for more engagement with care, people who inject drugs (PWID) are hard to reach with HCV testing and treatment. We initiated a study to evaluate the efficacy for testing and linkage to care among PWID consulting peer-based testing at a mobile clinic in Copenhagen, Denmark.Methods and analysisIn this intervention study, we will recruit participants at a single community-based, peer-run mobile clinic. In a single visit, we will first offer participants a point-of-care HCV antibody test, and if they test positive, then they will receive an HCV RNA test. If they are HCV-RNA+, we will administer facilitated referrals to designated ‘fast-track’ clinics at a hospital or an addiction centre for treatment. The primary outcomes for this study are the number of tested and treated individuals. Secondary outcomes include individuals lost at each step in the care cascade.Ethics and disseminationThe results of this study could provide a model for targeting PWID for HCV testing and treatment in Demark and other settings, which could help achieve WHO HCV elimination targets. The Health Research Ethics Committee of Denmark and the Danish Data Protection Agency confirmed (December 2018/January 2019) that this study did not require their approval. Study findings will be disseminated through peer-reviewed publications, conference presentations and social media.

Hepatitis C Micro-Elimination beyond Prison Walls: Navigator-Assisted Test-and-Treat Strategy for Subjects Serving Non-Custodial Sentences

“…At least, around Spain there are several similar centers with almost comparable resources than can implement this model of care. Pretty similar models are already working in addictions center and mobile clinics (Denmark) [ 34 , 35 ], where peers [ 36 ] help people to join these centers to take screening tests and to enroll harm reduction program and treatment facilities in Canada [ 37 ] and Mexico [ 38 ].…”

Peer support in small towns: A decentralized mobile Hepatitis C virus clinic for people who inject drugs

“…[27][28][29][30] Promising outcomes have been reported following POC testing in community-based services, including needle and syringe programs, pop-up clinics, mobile harm reduction units and community pharmacies. [31][32][33][34][35][36][37] Although there are examples of successful mobile HCV clinics, 32,35,37 they have been conducted in typical urban settings, and few have combined POC testing with peer support.…”

Differences in the hepatitis C virus cascade of care and time to initiation of therapy among vulnerable subpopulations using a mobile unit as point‐of‐care

“…10 Alternative MoCs using novel screening (eg onsite HCV polymerase chain reaction [PCR] tests) and linkage to care (eg using peer-navigators) strategies and others such as nurse-led, telemedicine, pharmacist-led and mobile van units have been used with PWID and homeless people with success. 11,[14][15][16] One of the hallmarks of these MoCs is their simplicity, which, along with other elements such as effective linkage to care and integration of services, are key to the scaling up of interventions and are widely considered as predictors of success. 11,17 However, due to biosocial determinants and transient lifestyles, it remains difficult to reach and treat some groups such as people with an MHD or alcohol use disorder (AUD).…”

“…Survival analysis: Cox's proportional hazard model and Aalen's additive regression modelThe implementation of PoC-based rapid screening in combination with a simplification of the linkage-to-care process has the benefit of significantly reducing diagnosis time and improves the likelihood of and reduces the time to HCV treatment initiation2,31,32 even in prison settings 34. Nevertheless, the time to HCV treatment initiation using rapid PoC screening among different vulnerable subgroups has not been well described.…”