Peer support in small towns: A decentralized mobile Hepatitis C virus clinic for people who inject drugs.

BACKGROUND & AIMS: New models of HCV care are needed to reach people who inject drugs (PWID). The primary aim was to evaluate HCV treatment uptake among HCV RNA positive individuals identified by point-of-care (POC) testing and liver disease assessment in a peer-driven decentralized mobile clinic. METHODS: This prospective study included consecutive patients assessed in a mobile clinic visiting 32 small towns in Southern Norway from November 2019 to November 2020. The clinic was staffed by a bus driver and a social educator offering POC HCV RNA testing (GeneXpert®), liver disease staging (FibroScan® 402) and peer support. Viremic individuals were offered prompt pan-genotypic treatment prescribed by local hospital-employed specialists following a brief telephone assessment. RESULTS: Among 296 tested individuals, 102 (34%) were HCV RNA positive (median age 51 years, 77% male, 24% advanced liver fibrosis/cirrhosis). All participants had a history of injecting drug use, 71% reported past 3 months injecting, and 37% received opioid agonist treatment. Treatment uptake within 6 months following enrolment was achieved in 88%. Treatment uptake was negatively associated with recent injecting (aHR 0.60; 95% CI 0.36-0.98), harmful alcohol consumption (aHR 0.44; 95% CI 0.20-0.99), and advanced liver fibrosis/cirrhosis (aHR 0.44; 95% CI 0.25-0.80). HCV RNA prevalence increased with age (OR 1.81 per 10-year increase; 95% 1.41-2.32), ranging from 3% among those <30 years to 55% among those ≥60 years. CONCLUSIONS: A peer-driven mobile HCV clinic is an effective and feasible model of care that should be considered for broader implementation to reach PWID outside the urban centres.

Fatal overdoses and deaths by other causes in a cohort of Norwegian drug abusers--a competing risk approach.

OBJECTIVE: To identify causes of death among Norwegian drug abusers and to investigate the risk factors for fatal overdose and other causes of death, with specific attention to ageing and duration of abuse. METHODS: In a cohort of 501 drug abusers admitted to treatment in the period 1981-1991, mortality has been calculated as incidence rates. The analyses of time to death were conducted as proportional hazard regression models using a competing risk approach. RESULTS: Crude incidence rates for all deaths and overdose deaths did not vary with age. For non-overdose deaths, however, the incidence was significantly higher after the age of 40. Explanatory factors associated with age at fatal overdoses are also associated with age at death by other causes. At every age the risk of death was higher with a long-term abuse of drugs, and more so for fatal overdose than for death by other causes. CONCLUSIONS: With respect to fatal overdose duration of abuse, but not ageing, is found to be a risk factor. With respect to death by other causes both ageing and duration of abuse are factors associated with such death.