title: Factors to improve the management of hepatitis C in drug users: an observational study in an addiction centre.
abstract: Barriers to management of HCV in injection drug users are related to patients, health providers, and facilities. In a primary care drug user's addiction centre we studied access to HCV standard of care before and after using an onsite total care concept provided by a multidisciplinary team and noninvasive liver fibrosis evaluation. A total of 586 patients were seen between 2002 and 2004. The majority, 417 patients, were HCV positive and of these patients 337 were tested positive for HCV RNA. In 2002, patients were sent to the hospital. with the Starting of 2003, patients were offered standard of care HCV management in the center by a team of general practitioners, a consultant hepatologist, psychiatrists, nurses, and a health counsellor. Liver fibrosis was assessed by a non invasive method. In 2002, 6 patients had liver fibrosis assessment at hospital facilities, 4 patients were assessed with liver biopsy and 2 patients with Fibrotest-Actitest. 2 patients were treated for HCV at hospital. In 2003 and 2004, 224 patients were assessed with Fibrotest-Actitest on site. Of these, 85 were treated for HCV. SVR was achieved in 43%. We conclude that the combination of an onsite multidisciplinary team with the use of a noninvasive assessment method led to improved management of HCV infection in drug users' primary care facility.
authors.affiliation: Service d'hépatologie, Université Pierre et Marie Curie Liver Center, Hôpital La Pitié Salpêtrière, 75013 Paris, France.
authors.forename: Joseph
authors.initials: J
authors.lastname: Moussalli
authors.forename: Helene
authors.initials: H
authors.lastname: Delaquaize
authors.forename: Dominique
authors.initials: D
authors.lastname: Boubilley
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Lhomme
authors.forename: Jules
authors.initials: J
authors.lastname: Merleau Ponty
authors.forename: David
authors.initials: D
authors.lastname: Sabot
authors.forename: Anne
authors.initials: A
authors.lastname: Kerever
authors.forename: Marc
authors.initials: M
authors.lastname: Valleur
authors.forename: Thierry
authors.initials: T
authors.lastname: Poynard
references.citation: Drug Alcohol Depend. 2002 Jul 1;67(2):117-23
references.pmid: 12095661
references.citation: Eur J Gastroenterol Hepatol. 2006 Feb;18(2):159-66
references.pmid: 16394797
references.citation: Hepatology. 2004 Jul;40(1):120-4
references.pmid: 15239094
references.citation: J Viral Hepat. 2002 Jan;9(1):62-70
references.pmid: 11851904
references.citation: Hepatology. 2003 Feb;37(2):443-51
references.pmid: 12540795
references.citation: Hepatology. 2007 Oct;46(4):991-8
references.pmid: 17668880
references.citation: Eur Addict Res. 2007;13(4):216-21
references.pmid: 17851243
references.citation: J Subst Abuse Treat. 2005 Oct;29(3):159-65
references.pmid: 16183464
references.citation: Addiction. 2007 Mar;102(3):423-31
references.pmid: 17298650
references.citation: Hepatology. 2002 Nov;36(5 Suppl 1):S210-9
references.pmid: 12407596
references.citation: Hepatology. 2007 Jan;45(1):111-7
references.pmid: 17187435
references.citation: J Community Health. 2008 Jun;33(3):126-33
references.pmid: 18165889
references.citation: Clin Infect Dis. 2005 Apr 15;40 Suppl 5:S325-9
references.pmid: 15768342
references.citation: Am J Gastroenterol. 2003 Oct;98(10):2281-8
references.pmid: 14572580
references.citation: J Gastroenterol Hepatol. 2007 Sep;22(9):1519-25
references.pmid: 17645460
references.citation: Hepatology. 2001 Jul;34(1):188-93
references.pmid: 11431750
references.citation: Drug Alcohol Depend. 2008 Jan 11;93(1-2):141-7
references.pmid: 17997050
references.citation: Clin Ther. 2002 Oct;24(10):1627-35
references.pmid: 12462291
references.citation: Int J Drug Policy. 2007 Oct;18(5):437-43
references.pmid: 17854734
references.citation: Lancet. 2001 Sep 22;358(9286):958-65
references.pmid: 11583749
references.citation: AIDS. 2006 Nov 28;20(18):2361-9
references.pmid: 17117023
references.citation: J Hepatol. 1997 Apr;26(4):794-7
references.pmid: 9126791
references.citation: N Engl J Med. 2002 Sep 26;347(13):975-82
references.pmid: 12324553
references.citation: Epidemiol Infect. 2005 Apr;133(2):305-14
references.pmid: 15816156
references.citation: Hepatology. 2002 Nov;36(5 Suppl 1):S35-46
references.pmid: 12407575
references.citation: Clin Infect Dis. 2005 Apr 15;40 Suppl 5:S336-8
references.pmid: 15768344
references.citation: Gastroenterol Clin Biol. 2002 Apr;26 Spec No 2:B138-43
references.pmid: 12180281