Why is this important?
France has set itself the goal of eliminating HCV by 2025. But it is estimated that 100,000 patients were still infected in 2019. To achieve this goal, effective and innovative screening policies are needed to promote access to treatment, especially among patients furthest from care, such as injection drug users (IDUs). Also, Scanvir was designed and built to test and treat these patients in their own environment.
The success of Scanvir is due to dedicated screening days, a multidisciplinary team, innovative screening technologies and pangenotypic treatments. The strategy also offers screening for associated chronic liver diseases, such as alcoholism, hepatitis B virus (HBV), liver toxicity from psychotropic drugs and non-alcoholic steatohepatitis.
Scanvir has since its initiation been transposed in other French regions, with a strategy adapted to local constraints, as well as in prison structures. It will soon be in other structures such as those aimed at welcoming migrants or prostitutes. He was the subject of a BBC report.
Methodology
This prospective study was conducted in addiction care centers (CSAPA) in four departments (Haute-Vienne, Corrèze, Creuse and Dordogne) in which the program was offered. An average of 4 screening days per center and per year was carried out between May 2017 and March 2021 (except between March and September 2020).
The program involved various professionals (hepatologists/infectiologists, addictologists, nurses, etc.), peer helpers from patient associations and the Addictlim multidisciplinary transversal network (psychiatrists/addictologists, general practitioners, pharmacists and social workers). Screening actions were announced: on a dedicated website, social networks, posters and flyers in general medicine practices, pharmacies, associations, etc. In some territories, means of transport were made available so that subjects wishing to participate go there.
Any major person formerly or currently UDI wishing to participate was welcomed for a friendly and non-judgmental individual interview. During this meeting, she was offered rapid screening tests (TROD) for the three viral pathologies (HBV, HCV, HIV) but she was the only decision-maker. A measurement of hepatic stiffness by FibroScan was also performed. Positive HCV TRODs were supported by a rapid HCV PCR. Those who had a positive diagnosis or a worrying liver test were offered specialist consultations, additional tests, addiction treatment and prevention support.
Principle results
The study included 392 IDU patients who participated in 67 Scanvir sessions. Among them, 72% were men and the average age was 45 years old. They were 14% to regularly inject drugs and 57.2% snorted cocaine. Among them, 35.2% had undergone opioid substitution treatment (OST). They were also 66.4% to have an excessive consumption of alcohol, 46.3% to be consumers of cannabis and 78.6% of tobacco.
FibroScan was accepted by 99.5% of patients and TROD for HCV, HBV or HIV by 62.3%, 60.5% and 63.6% of patients respectively. The positivity rates were 17.1%, 2% and 0.9% respectively.
Among the 392 patients, the HCV antibody positivity rate was 31.6% and 45.3% among active IDUs. The rate of patients with detectable HCV-RNA was 20.9%.
Anti-HCV treatment was initiated by 79.3% of the 82 viraemic patients. They were 38 to obtain a sustained virological response (SVR), 27 being still under treatment. No relapse or non-response was recorded. Most untreated patients were homeless and illegal migrants.