World Hepatitis Day: Focus on the ICONE Project
Inspired by the DRIVE studies in Vietnam, ICONE is a proof-of-concept project conducted in Montpellier to demonstrate the efficacy of a community-based intervention in the screening and treatment of hepatitis C among drug users (DUs) – a population with poorer access to the healthcare system. Doctor and researcher Hélène Donnadieu-Rigole, head of the Addiction Medicine Department at University Hospital Montpellier (Inserm team U1058) is its principal investigator.
ICONE was devised by the Inserm U1058 research team following the various DRIVE studies conducted in Vietnam. The aim was to implement a Respondent-Driven Sampling (RDS) recruitment method in France, to reach populations with poorer access to healthcare structures. The primary objective was to evaluate the effectiveness of a community-based model of hepatitis C virus (HCV) mass screening associated with immediate treatment initiation on improvement of the cascade of care among active DUs in the city of Montpellier. DUs represent a population at risk for this virus and their access to care is not always fluid.
We based this study on two elements: the RDS method and "peer support", which enabled peer users employed by the study to participate at all stages of the research and care.
A number of associations local to Montpellier were involved right from the start of the reflection process, and worked alongside the U1058 research team: addiction medicine support and prevention facilities and associations (University Hospital Montpellier Addiction Medicine Department, CSAPA AMT, CAARUD axess Réduire les risques), plus associations fighting exclusion – Avitarelle, SAMU social emergency outreach service for the homeless, global health structures, healthcare stayover centers (LHSS), and medicalized shelter beds (LAM) for the homeless.
Their involvement enabled us to recruit the peers employed, to choose people (the "seeds") at the origin of the recruitment chains, to facilitate social administrative processes, and welcome healthcare service users following the closure of the RDS structure.
This study has established a dynamic in Montpellier favoring the healthcare of DUs and fluidifying their pathways. It has also provided an opportunity for one of the peer users to maintain a professional activity within a harm reduction center (CAARUD).
In 11 weeks, 554 DUs were recruited to the study, 75% of whom were not being monitored in an addiction medicine facility. The majority were multi-users living in highly precarious situations. Of the 8.8% diagnosed with chronic HCV, 76% were treated and 55% cured.
This study has demonstrated that the RDS recruitment method is highly effective and can be used in France. A majority of users who were not being monitored were able to be treated and cured thanks to the high level of involvement of the peers employed in the study. Thus, the employment of peers in recruiting and supporting user care is an effective measure. This study could be considered as a "proof of concept" for its larger-scale rollout in France.
Links to the rest of the kit produced as part of World Hepatitis Day 2022:
- Focus on TA-PROHM, a project to limit mother-child transmission of the hepatitis B virus in Cambodia: https://www.anrs.fr/en/actualites/1126/world-hepatitis-day-focus-ta-prohm-project
- Interview with Fabien Zoulim and focus on Julie Lucifora’s research: https://www.anrs.fr/en/actualites/1124/world-hepatitis-day-interview-fabien-zoulim-and-focus-julie-luciforas-research
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