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Introduction and objective: HCV treatment for all was effective in France since 2017. HCV testing, diagnosis and treatment of drugs users and precarious people remain low. Lost follow-up was too important since several stages are necessary. Pangenotypic direct antiviral agents were available. Point-of-care HCV RNA testing offers advantage over antibody testing, enabling diagnosis of active infection with real time measure in a single visit. It is missing link between HCV RDT, liver fibrosis evaluation by FIBROSCAN and treatment. Validated Xpert HCV Viral Load assay CEPHEID, fast training technique, allow developing projects of diagnosis to treatment session. Our objective was to evaluate test to cure session allowing the access in 5 hours to an antiviral treatment to vulnerable and precarious populations (drug users, migrants, psychiatric patients).
Materials and methods: Eligible patients had to have known positive serology or risk behavior, an unknown or unchecked viral load after antiviral treatment; 5 to 7 patients were recruited per each session by social or nursing interview. Between 9 am and 2 pm these patients had access to measure of the hepatic fibrosis by FIBROSCAN, HCV viral load in real time by CEPHEID Xpert HCV Viral load finger-stick samples, social interview, shared educational evaluation, collective workshops, especially harm reduction, depiction of results by hepatologist and prescription of DAA (sofosbuvir velpastasvir combination) allowed delivery of 1st month of treatment. Specific social and nursing follow-up was made during and after treatment. Compliance and sustained virological rate were determinate at week 12.
Results: From October 2019 to December 2021, 223 sessions were realized on 27 sites: 9 drug units, one prison, 17 social units; 1602 patients with drug using history were screened; 427 patients had HCV positive serology and 24 patients did not come; 403 FIBROSCAN measures and 403 measures of viral load in real time were realized. Mean value of liver stiffness was 8.2 and 29% of patients were F3 or F4: 229 patients were HCV RNA positive (56.8%), 57 declared knew their HCV status; 228 treatments began same day, only 1 was delayed due to default social rights; 120 patients had a negative viral load spontaneously and 54 following prior treatment; 399 social interviews and 405 collective workshops were realized. On 31st January 2022, 207 antiviral treatments were completed and 199 patients were cured; 12 patients interrupted treatment; 3 patients relapsed and 5 reinfections; 89% of patients were satisfied with this program.
Conclusions: Despite 3 months interruption by COVID 19 pandemic lockdown and sanitary restrictions, 94% of positive participants were linked to care and cure with this mobile clinic model, by screening and RNA real time measure in unity of place adapted to precarious public, patients distant from system of care had access immediately to treatment.
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