Prise en charge de l'hépatite C dans les populations vulnérables

 

Valérie Martel-Laferrière

Centre de recherche du Centre hospitalier de l'Université de Montréal

 

Domaine :  services de santé

Programme chercheurs-boursiers-cliniciens  - Junior 1

Concours 2017-2018

Over the last five years, treatment for hepatitis C (HCV) has become completely transformed.  The approval of highly efficient and well-tolerated new treatments have made it possible to treat and cure virtually all infected patients. Now that cures are no longer a challenge anymore, we fully realize that involvement from both patients and physicians is essential to eliminate HCV on a population scale.

HCV screening poses a challenge, because patients develop symptoms relatively late after infection.  Current screening is based on risk factors such as injection drug use or blood transfusions.  However, this strategy misses the mark in a significant number of cases.  The same phenomenon is seen in HIV, a disease that bears much resemblance to HCV.  The first project of this program will evaluate HCV and HIV screening in all patients who present to the emergency room.  The goal is to determine whether this strategy will identify a sufficient number of new cases to justify expanding this approach to all other emergency rooms in Quebec.

Additionally, patients' engagement in health care after diagnosis is sub-optimal, especially in vulnerable populations such as persons who inject drugs.  Pre-treatment evaluation requires multiple tests and medical appointments.  Vulnerable patients face much instability and are not well served by traditional health care.  They have difficulty completing pre-treatment assessments and can often disengage from medical follow up before treatment initiation.  The second project of this program will evaluate if pre-treatment evaluation completed in one appointment will result in in a higher proportion of treatment initiation in patients using drugs, as compared to the traditional evaluation in multiple appointments.