a first assessment since the launch of mobile screening for drug users

In November 2021, the Nancy CHRU facilitated screening for the hepatitis C virus and access to antiviral treatment among infected drug users thanks to the deployment of a mobile unit (camper van).

At the initiative of Professor Jean-Pierre Bronowicki, head of the hepato-gastroenterology department and Sylvie Ehrhart, state-certified nurse, this project was to contribute to meeting the objective set by the Ministry of Health and Solidarity: eliminate the hepatitis C virus in France by 2025. At the dawn of 2025, the Nancy University Hospital is taking stock of this mobile screening.

Tours to reach those furthest from care
Since December 2021, nearly 287 sorties have been carried out with the mobile unit. Working mainly with social structures such as CAARUD (Reception and Support Center for Risk Reduction for Drug Users), CSAPA (Addictology Care, Support and Prevention Center), the camper van travels also in day centers (Epinal, Neufchâteau, Longwy, Briey) where the team meets homeless people, CHRS (Accommodation and social reintegration centers) (Pont-à-Mousson, Gérardmer), guesthouses and homes in Nancy.

1,320 consultations, including 666 with active drug users, were carried out. Patients are included in the therapeutic education program of the hepato-gastroenterology department (validated by the ARS since 2014). Only around ten patients did not wish to join this program.

This program allows risk reduction, knowledge of viral hepatitis, fibrosis, cirrhosis, awareness of the risks of alcohol consumption, “off-course” medications, substance use and compliance with the treatment.

Excessive alcohol consumption
Following the 1,101 fibroscans carried out, 197 people were screened for significant fibrosis or cirrhosis which required close monitoring. A care pathway is organized on the day of the consultation for these patients either to the hepato-gastroenterology department of the Nancy CHRU, or to a hepatologist at the hospital closest to the patient.

A difficult to achieve objective for 2025
The HCV eradication objective for 2025 has not been achieved in France.
This perspective seems possible for 2030, but screening must continue in populations at risk: drug users, migrants, psychiatric and prison populations).

It is also highly desirable that general practitioners adopt the simplified pathway put in place in 2019 by the High Authority of Health (introduction of AAD treatments (direct-acting antivirals) for patients without comorbidities and without fibrosis).

Teamwork with the CHRU logistics services
This mobile unit project is made possible because of the involvement of Sylvie Ehrhart and the links established with the logistics services of the Nancy CHRU:

Transport: organization of the schedule of drivers seconded specifically to drive the mobile unit to the structures,
Catering: preparation of tour meals and convivial moments (coffee, cakes, fruit juice),
The mechanical workshop: vehicle maintenance, interior work, etc.

In 2025, a new IDE will be formed to integrate and strengthen the mobile unit team.