1 / 30

André-Jean REMY (1,2) (1) Hepatitis Mobile Team, Service of Gastroentrology,

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

jamesagreen
Download Presentation

André-Jean REMY (1,2) (1) Hepatitis Mobile Team, Service of Gastroentrology,

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. 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 Andre.remy@ch-perpignan.fr 1

  2. HEPATITIS MOBILE TEAM 800 km 200 km Barcelona

  3. 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

  4. HCV in France (2) • Number of treated patients • 2012 12000 • 2013 6000 • 2014 10800 • 2015 14000

  5. French guidelines February 2016 1/ Treat all patients with liver fibrosis F2 F3 F4and.. 2/ Treat all drugs users and inmates even if no liver fibrosis  100% of frenchDU/ inmates have to be treated for HCV infection! 4

  6. 2016 HEPATITIS MOBILE TEAM • 1 Hepatologist • 1 Nurse coordinator • 3 othernurses (2 for psycho educative intervention) • 1 Secretary • 2 Social workers • 2 Health care workers •  For a multidisciplinaryapproach 8

  7. HEPATITIS MOBILE TEAM - 3 specific cars + 1 truck -3 Fibroscan - POCT/DBS HIV/HCV/HBV 9

  8. Target population • Drugs users • Prisoners • Psychiatric patients • Homeless • Precarious people • Migrants

  9. Associative sector PARTNERS ORGANIZATIONS • Asyleum medical unit • Jailhouse medical unit • Primary care access unit • Pharmacy • TB unit • Addictology service • Gastroenterology service • Medical duty home Hospitalservices • One Day hospital and Psychiatric Mobile Team • Mao – psychiaitric diagnosis and orientation module Psychiatric Hospital HEPATITIS MOBILE TEAM • Methadon centers • Low threesold drug center • Housing units • Therapeutic Coordination Apartment • Day reception and home association Outside hospital Patients association Psychoeducative network Hepatitis network 10

  10. Associative sector PARTNERS ORGANIZATIONS • Asyleum medical unit • Jailhouse medical unit • Primary care access unit • TB unit • Addictology service • Gastroenterology service • Medical duty home Hospitalservices 500 000 people area • One Day hospital and Psychiatric Mobile Team • Mao – psychiaitric diagnosis and orientation module Psychiatric Hospital HEPATITIS MOBILE TEAM • Methadon centers • Low threesold drug center • Housing units • Therapeutic Coordination Apartment • Day reception and home association Outside hospital Patients association Psychoeducative network Hepatitis network 12

  11. 15 SERVICES « à la carte » • Early detection / Primary prevention • 1. Screening / Point of Care Testing POCT (HIV HBV HCV) • 2. Green thread: outsidePOCT/DBS (driedblood spot) and FIBROSCAN* withspecific 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 liverstiffness Fibroscan* (indirect measurement of liverfibrosis) in site • 8. Advanced on-site specialistconsultation • 9. Free access to hospitalblood tests care 13

  12. 15 SERVICES « à la carte » • Access to treatment • 10. Easyaccess to pre-treatment commission (“RCP”) withhepatologists, nurse, pharmacist, social worker, GP, psychiatric and/or addictologist.. • 11. Lowcost mobile phones for patients • Follow up during and after treatment • 12. Individualpsychoeducative intervention sessions • 13. Collective educative workshops • 14. Peer to peereducational program • 15. Specific one dayhospitalizations 13

  13. 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 14

  14. 244 HCV followed patients

  15. 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%) 93 cured patients + 26 in treatment (49%) / only 2 stop treatment

  16. 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…

  17. 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

  18. Objective • use HCV POCT in prison • as a supplement to the classic serology • study the incidence of new HCV infections in prisoners

  19. 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

  20. 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-month-old superior and previous negative serology

  21. 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 HCVstatus as soon as necessary 15

  22. Methods (2) • In case of positivity  we did FIBROSCAN • And complementary blood tests

  23. 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) 16

  24. Results (1) • 333 HCV POCT was realized in 24 months • group 1 15 % (refusal) • group 2 27 % (transfer) • group 3 58 % (> 12 months detention)

  25. 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

  26. 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

  27. Risk of HCV reinfectionin 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

  28. 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

  29. THANK YOU FOR YOUR ATTENTION !!!

  30. ANY QUESTIONS ?

More Related