Increased Uptake of HCV Testing through a Community-Based Educational Intervention in Difficult-to-Reach People Who Inject Drugs: Results from the ANRS-AERLI Study.
OBJECTIVE
The community-based AERLI intervention provided training and education to people who inject drugs (PWID) about HIV and HCV transmission risk reduction, with a focus on drug injecting practices, other injection-related complications, and access to HIV and HCV testing and care. We hypothesized that in such a population where HCV prevalence is very high and where few know their HCV serostatus, AERLI would lead to increased HCV testing.


METHODS
The national multisite intervention study ANRS-AERLI consisted in assessing the impact of an injection-centered face-to-face educational session offered in volunteer harm reduction (HR) centers ("with intervention") compared with standard HR centers ("without intervention"). The study included 271 PWID interviewed on three occasions: enrolment, 6 and 12 months. Participants in the intervention group received at least one face-to-face educational session during the first 6 months.


METHODS
The primary outcome of this analysis was reporting to have been tested for HCV during the previous 6 months. Statistical analyses used a two-step Heckman approach to account for bias arising from the non-randomized clustering design. This approach identified factors associated with HCV testing during the previous 6 months.


RESULTS
Of the 271 participants, 127 and 144 were enrolled in the control and intervention groups, respectively. Of the latter, 113 received at least one educational session. For the present analysis, we selected 114 and 88 participants eligible for HCV testing in the control and intervention groups, respectively. In the intervention group, 44% of participants reported having being tested for HCV during the previous 6 months at enrolment and 85% at 6 months or 12 months. In the control group, these percentages were 51% at enrolment and 78% at 12 months. Multivariable analyses showed that participants who received at least one educational session during follow-up were more likely to report HCV testing, compared with those who did not receive any intervention (95%[CI] = 4.13[1.03;16.60]).


CONCLUSIONS
The educational intervention AERLI had already shown efficiency in reducing HCV at-risk practices and associated cutaneous complications and also seems to have a positive impact in increasing HCV testing in PWID.
INSERM U912 (SESSTIM), Marseille, France.|Aix Marseille Université, IRD, UMR-S912, Marseille, France.|ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France.
Perrine
P
Roux
AIDES, Pantin, France.|Médecins du Monde, Paris, France.
Daniela
D
Rojas Castro
INSERM U912 (SESSTIM), Marseille, France.|Aix Marseille Université, IRD, UMR-S912, Marseille, France.|ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France.
Khadim
K
Ndiaye
Médecins du Monde, Paris, France.
Marie
M
Debrus
INSERM U912 (SESSTIM), Marseille, France.|Aix Marseille Université, IRD, UMR-S912, Marseille, France.|ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France.
Camélia
C
Protopopescu
AIDES, Pantin, France.
Jean-Marie
JM
Le Gall
AIDES, Pantin, France.
Aurélie
A
Haas
INSERM U912 (SESSTIM), Marseille, France.|Aix Marseille Université, IRD, UMR-S912, Marseille, France.|ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France.
Marion
M
Mora
INSERM U912 (SESSTIM), Marseille, France.|Aix Marseille Université, IRD, UMR-S912, Marseille, France.|ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France.|AIDES, Pantin, France.
Bruno
B
Spire
INSERM U912 (SESSTIM), Marseille, France.|Aix Marseille Université, IRD, UMR-S912, Marseille, France.|ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France.|AIDES, Pantin, France.
Marie
M
Suzan-Monti
INSERM U912 (SESSTIM), Marseille, France.|Aix Marseille Université, IRD, UMR-S912, Marseille, France.|ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France.
Patrizia
P
Carrieri
D000328:Adult; D003256:Community Participation; D005260:Female; D005602:France / Q000453:epidemiology; D040261:Harm Reduction; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D016174:Hepacivirus / Q000302:isolation & purification*; D006526:Hepatitis C / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data*; D018671:Needle-Exchange Programs / Q000458:organization & administration / Q000706:statistics & numerical data; D010353:Patient Education as Topic; D040242:Risk Reduction Behavior; D012309:Risk-Taking; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology