Short summary

To obtain the WHO target of 80% of diagnosed patients in the mobile clinic initiating treatment and obtain cure.

Secondary aim will be to re estimate the hidden hepatitis C population in Region South based on multiple field visits with testing of various subpopulations. In addition, to validate different strategies to improve test coverage in marginalized populations.

Rationale

Hepatitis C has with the introduction of safe and effective treatment in 2015 become a disease that can be controlled. Denmark has decided to fulfil the WHO hepatitis elimination goals by 2030.

The treatment is effective, but can only be given to the patients (7500 citizens in Denmark) who have been diagnosed with Chronic Hepatitis C infection (HCV). Finding the residuals is a difficult task.

In the Region of Southern Denmark (pop 1.2 million), the estimated total number of patients with HCV in the region to be 3000 (2000-6000). Of these 2/5 are diagnosed but without contact to the health care system and one in four are undiagnosed. The group of diagnosed patients without contact to the healthcare system and undiagnosed consists primarily of vulnerable citizens: former or current drug users not utilizing drug treatment programs or primary care.

There are several best practice examples on how outreach mobile clinics can provide hepatitis C screening and linkage to care and in some cases also treatment. A common denominator is "to follow the people". Engaging with local initiatives that provide care or engage with marginalized populations can overcome the structural barriers in access to specialized health care. Little is known about hepatitis C awareness, test-uptake and prevalence in the more rural areas of Denmark.

We think that systematic screening of risk groups is the most effective strategy to identify patients with Hepatitis C in marginalized populations. If this is combined with treatment evaluation "on-site" and "a one stop shop" approach, patients with detected viremic HCV infections can access treatment with no delay and less loss to follow-up. The population will include persons with alcohol misuse, current or former drug, patients with mental illness, homeless and refugees.

Description of the cohort

Cross sectional sampling, with formation of a prospective cohort of hepatitis c infected.

Target population: Persons utilizing shelters, cafés and facilities targeting people with drug or alcohol misuse and/or psychiatric illnesses.

Expected number of persons engaged: 900-1500 each year

Population for research question: All persons engaged in hepatitis C testing at the C-Free South mobile test unit in RSD

Data and biological material

We collect the following data:

Participant generated: Demographics, past and present drug and alcohol use, additional risk factors.

Lab data: Outcomes for HIV, Hepatitis C and B test.

Data collected in hepatitis c patients: Study treatment received, adverse events, outcome of treatment, viral load.

Collaborating researchers and departments

Department of Infectious Diseases

• Sandra Dröse
• Anne Øvrehus