Transcript POWER 2: shortened poster title

Role of harm reduction in HCV
prevention in France: from research to
scale up
Bruno Spire & Patrizia Carrieri
How to reduce HCV incidence
among people who use drugs?
 Increasing
access to effective treatment for opioïd
dependence (e.g. methadone)
 Diversifying
harm reduction tools for safer drug
consumption
 Increasing
access to HCV treatment as prevention
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The ANRS Methaville trial (1)

Methadone included in the WHO list of essential medicines thanks to
its effectiveness in
 treating opioïd dependence
 preventing HIV
 improving adherence to ART

Limited access to methadone due to overdose risk during induction.

In France: buprenorphine initiated in primary care but not methadone

Many rural areas underserved because of lack of specialized centers
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The ANRS Methaville trial (2)

Increasing access to methadone in France using
primary care as an entry point
=> Evaluate the feasibility of methadone induction in
primary care by a non-inferiority pragmatic trial

Primary outcome: % of patients abstinent from nonprescribed opioïds after 12 months
ROUX, BMC PUBLIC HEALTH 2012
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The ANRS Methaville trial (3)

Non-inferiority of induction in primary
care compared to specialized care on 12month abstinence from non-prescribed
opioîds

•
difference between
the proportion of
patients abstinent
from street-opioïds
between both arms
at M12
Significant lower engagement in care of
patients randomized in specialized
centers

Methadone duration significantly
associated with an increase of abstinence
from non-prescribed opioîd use
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The ANRS Methaville trial: (4)
 Less than half of the patients were adherent. Non-
adherence was associated with cocaine use and
perceiving methadone dose as inadequate
ROUX, CURR PHARM DES 2013
 At
M12, 68% of patients did not use non-
prescribed opioïds. A good patient-provider
relationship was the most important predictor
LIONS, DAD 2014
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How to reduce HCV incidence
among people who use drugs?
 Increasing
access to effective treatment for opioïd
dependence (e.g. methadone)
 Diversifying
harm reduction tools for safer drug
consumption

Injection and other modes of consumption at risk of
HCV transmission

Rising use of stimulants
 Increasing
access to HCV treatment as prevention
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The ANRS AERLI study

Objective : to assess the effectiveness of communitybased intervention of training and education to injection on
HIV and other blood borne disease risk reduction in
France.

Design : controlled clustered interventional study
conducted in low-threshold services.
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The ANRS AERLI study
 Outcomes:
HIV-HCV risk practices &complications
at the injection site at M6-12
 Results
: exciting! See you on ThAC0403
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The crack pipe study

Crack is smoked through glass pipes that can lead to
severe injuries which facilitate HCV transmission

Design : Before/ after intervention study

Intervention : distribution on Pyrex crack pipes on
350 crack users

Outcome : presence of face or hands injuries

Results : decrease from 90% at baseline to 30%
after 18 months of intervention
JAUFFRET-ROUSTIDE, BEH 2010
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The STIMAGO ANRS study


Background :

increased use of stimulants

no pharmacological treatment for stimulant dependence

dopaminergic agents as possible agonist substitution treatments
Objective : evaluating the efficacy of Methylphenidate on
cocaine dependence.

Outcomes: self-reported abstinence from non prescribed
stimulants use; craving score, urine toxicologies and MP
plasma concentrations
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How to reduce HCV incidence
among people who use drugs?
 Increasing
access to effective treatment for opioïd
dependence (e.g. methadone)
 Diversifying
harm reduction tools for safer drug
consumption
 Increasing
access to HCV treatment as prevention
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The role of general practitioners in
access to HCV
care

SALMON-CERON, BMC Health Serv Res. 2012

Objective: identifying the individual and structural correlates of
access to HCV treatment

Design: 3-year follow-up of HEPAVIH ANRS-CO13 cohort of patients
living with HIV and HCV.

Results: After a median follow-up of 12 months, 124 patients (21%)
had started HCV treatment.
Among structural factors, being followed-up by a general practitioner
working in a hospital was associated with HCV treatment initiation

Conclusion: Possible role of primary care to scale-up HCV treatment
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Positive impact of HCV treatment on
adherence to ART

Objective: Relationship between HCV treatment initiation and ART
adherence in HIV-HCV-coinfected individuals

Design: comparing visits of patients when receiving HCV treatment
with those of patient not yet receiving treatment

Results: Patients reported incomplete adherence to ART in 808
(68%) of the 1,190 visits.
After multiple adjustment, initiation of HCV treatment was associated
with improved ART adherence (OR= 2.6 95%CI[1.32-5.9])

Conclusions: Fear of reduced ART adherence should not be an
argument to deny access to HCV treatment
ROUX, ANTIVIR THER 2014
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