Transcript andr--jean-remy-perpignan-hospital-france

HEPATITIS MOBILE TEAM
INCIDENCE OF THE HEPATITIS C
IN PRISON IN FRANCE
RESULTS OF A STUDY BY POCT
André-Jean REMY (1,2)
(1) Hepatitis Mobile Team, Service of Gastroentrology,
(2)Consultation Unit and Ambulatory Care,
Hepatitis Reference Center, Perpignan Hospital, France
[email protected]
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HEPATITIS MOBILE TEAM
800 km
200 km
Barcelona
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HCV in France (1)
Global incidence 2700/4400 new
cases per year
150-200 000 HCV patients
75000 unaware patients
40-60 000 waiting for treatment
30-35 000 cured patients
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HCV in France (2)
Number of treated patients
2012 12000
2013 6000
2014 10800
2015 14000
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French guidelines February 2016
1/ Treat all patients with liver fibrosis
F2 F3 F4 and..
2/ Treat all drugs users and inmates
even if no liver fibrosis
 100% of french DU / inmates
have to be treated for HCV infection!
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2016 HEPATITIS MOBILE TEAM
 1 Hepatologist
 1 Nurse coordinator
 3 other nurses (2 for psycho
educative intervention)
 1 Secretary
 2 Social workers
 2 Health care workers
 For a multidisciplinary approach
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HEPATITIS MOBILE TEAM
3 specific cars + 1 truck
-3 Fibroscan
- POCT/DBS HIV/HCV/HBV
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Target population
Drugs users
Prisoners
Psychiatric patients
Homeless
Precarious people
Migrants
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PARTNERS ORGANIZATIONS
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Hospital
services
HEPATITIS
MOBILE TEAM
Associative
sector
Patients association
Psychoeducative network
Hepatitis network
Psychiatric
Hospital
Outside
hospital
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Asyleum medical unit
Jailhouse medical unit
Primary care access unit
Pharmacy
TB unit
Addictology service
Gastroenterology service
Medical duty home
• One Day hospital and
Psychiatric Mobile
Team
• Mao – psychiaitric
diagnosis and
orientation module
Methadon centers
Low threesold drug center
Housing units
Therapeutic Coordination
Apartment
• Day reception and home
association
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PARTNERS ORGANIZATIONS
•
•
•
•
•
•
•
Hospital
services
HEPATITIS
MOBILE TEAM
Associative
sector
Patients association
Psychoeducative network
Hepatitis network
500 000
Psychiatric
people
Hospital
area
Outside
hospital
•
•
•
•
Asyleum medical unit
Jailhouse medical unit
Primary care access unit
TB unit
Addictology service
Gastroenterology service
Medical duty home
• One Day hospital and
Psychiatric Mobile
Team
• Mao – psychiaitric
diagnosis and
orientation module
Methadon centers
Low threesold drug center
Housing units
Therapeutic Coordination
Apartment
• Day reception and home
association
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15 SERVICES « à la carte »
Early detection / Primary prevention
1. Screening / Point of Care Testing POCT (HIV HBV HCV)
2. Green thread: outside POCT/DBS (dried blood spot) and
FIBROSCAN* with specific truck
3. Outreach open center 5 days/7
4. Drug users information and prevention actions
5. Staff training
Clinical management :Linkage to care and fibrosis assesment
6. Social screening and diagnosis (EPICES score)
7. Mobile liver stiffness Fibroscan* (indirect measurement of
liver fibrosis) in site
8. Advanced on-site specialist consultation
9. Free access to hospital blood tests care
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15 SERVICES « à la carte »
Access to treatment
10. Easy access to pre-treatment commission
(“RCP”) with hepatologists, nurse, pharmacist,
social worker, GP, psychiatric and/or
addictologist..
11. Low cost mobile phones for patients
 Follow up during and after treatment
12. Individual psychoeducative intervention sessions
13. Collective educative workshops
14. Peer to peer educational program
15. Specific one day hospitalizations
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15 SERVICES « à la carte »
 Hepatitis mobile team offers hotlines "all in
one"
 Each structure according to its needs could
choose actions it wishes to include in its
draft
 For 1500 potential outpatients
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244 HCV followed patients
HIV HCV
COINFECTIO
N4
ALCOHOLO
L1
HBV 23
HCV 240
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HMT linkage care
1485 seen once
2056 DBS / 944 HCV DBS/ 414 Fibroscan
HCV positive 244 (100%)
FIBROSCAN + full blood tests done
202 patients in pretreatment commission(83%)
(61% of PTC cases)
146 HCV treatment decide (59%) / 56 only survey
121 started treatment(50%)
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93 cured patients + 26 in treatment (49%) / only 2 stop treatment
Introduction (1)
HCV rate is higher in the prisoners
population than in the general’s one in
France, between 5 and 7 % (INVS 2004,
PREVACAR)
Prisoners accumulate risk factors
before their confinement but the
prison in itself represents a risk
factor: syringes or straw share,
home-made tattoos…
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Introduction (2)
HCV incidence in prisons was not known
Screening of HCV is systematically proposed
in the entrance to detention in France,
recommended by the Methodological Guide of
sanitary care is not still applied correctly
point of care testing (POCT) use could
constitute an interesting alternative in classic
serology
POCT was recommended in French HCV
experts report in 2014 and in national
guidelines in 2016
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Objective
use HCV POCT in prison
as a supplement to the classic
serology
study the incidence of new
HCV infections in prisoners
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Methods (1)
HCV prevalence in our
establishment is situated in
national average around 7 %
HCV serology realized by venous
way was proposed to all incomers in
Perpignan detention center
 average 1500 per year
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Methods (2)
POCT was proposed to 3 types of
prisoners:
1/refusal or impossibility of venous
way
2/transfer of another penitentiary
and previous negative serology
3/presence in detention 12-monthold superior and previous negative
serology
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Point Of Care Testing
 POCT/DBS
HCV / HIV / HBV
 Alternative to blood test, but in case of
positive test  blood test confirmation is
necessary
 Quick on digital puncture
 Immediate results
 Free, renewal of HCV status as soon as
necessary
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Methods (2)
In case of positivity  we did
FIBROSCAN
And complementary blood tests
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Mobile FIBROSCAN
• Liver stiffness = measurement of hepatic
elasticity to detect liver fibrosis and liver
cirrhosis diagnosis
• Uninvasive testing with rapid results,
combined with DBS/POCT
• Performed by a nurse trained in the
framework of a Memorandum of
Cooperation (HSPT-Law Article 51)
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Results (1)
333 HCV POCT was realized in 24
months
group 1 15 % (refusal)
group 2 27 % (transfer)
group 3 58 % (> 12 months detention)
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Results (2)
2 serology were positive by POCT
2 inmates were imprisoned for more than
6 months
viral load was both positive
One patient had gone out in permission
one week
One patient had never gone out of
detention
Use of drugs was route of contamination
in 2 cases
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Results (3)
Calculated incidence in prison was
3/1000/year
potentially 470 new cases of HCV
infection in France a year among
the prison population
78246 prisoners on May 1st, 2016
in France
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Risk of HCV reinfection
in IVDU and prisoners
 Simmons and al, CID 2016: 62,
683-694
14 studies high-risk patients
IVDU and prisoners
Risk rate = 22.3/1000 person
years of follow up after HCV
treatment
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Discussion / conclusions
HCV POCT are useful in jailhouses
because there are HCV high risk
place
These route of contamination could
be more than 10% of HCV new
cases
So it was also necessary to give
harm reduction tools for all
prisoners like syringes share
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THANK YOU FOR YOUR ATTENTION !!!
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ANY QUESTIONS ?
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