Increased Uptake of HCV Testing through a Community-Based Educational Intervention in Difficult-to-Reach People Who Inject Drugs: Results from the ANRS-AERLI Study

Abstract

AimsThe community-based AERLI intervention provided training and education to people who inject drugs (PWID) about HIV and HCV transmission risk reduction, with a focus on drug injecting practices, other injection-related complications, and access to HIV and HCV testing and care. We hypothesized that in such a population where HCV prevalence is very high and where few know their HCV serostatus, AERLI would lead to increased HCV testing.MethodsThe national multisite intervention study ANRS-AERLI consisted in assessing the impact of an injection-centered face-to-face educational session offered in volunteer harm reduction (HR) centers (“with intervention”) compared with standard HR centers (“without intervention”). The study included 271 PWID interviewed on three occasions: enrolment, 6 and 12 months. Participants in the intervention group received at least one face-to-face educational session during the first 6 months.MeasurementsThe primary outcome of this analysis was reporting to have been tested for HCV during the previous 6 months. Statistical analyses used a two-step Heckman approach to account for bias arising from the non-randomized clustering design. This approach identified factors associated with HCV testing during the previous 6 months.FindingsOf the 271 participants, 127 and 144 were enrolled in the control and intervention groups, respectively. Of the latter, 113 received at least one educational session. For the present analysis, we selected 114 and 88 participants eligible for HCV testing in the control and intervention groups, respectively. In the intervention group, 44% of participants reported having being tested for HCV during the previous 6 months at enrolment and 85% at 6 months or 12 months. In the control group, these percentages were 51% at enrolment and 78% at 12 months. Multivariable analyses showed that participants who received at least one educational session during follow-up were more likely to report HCV testing, compared with those who did not receive any intervention (95%[CI] = 4.13[1.03;16.60]).ConclusionThe educational intervention AERLI had already shown efficiency in reducing HCV at-risk practices and associated cutaneous complications and also seems to have a positive impact in increasing HCV testing in PWID.

Elimination of hepatitis C virus infection among PWID: The beginning of a new era of interferon-free DAA therapy

“…Among 10,116 records identified, a total of 14 studies were included, of which 57% were randomised controlled trials. Interventions to enhance HCV testing included on-site testing with pre-test counselling and education (Cullen, et al, 2006;Hagedorn, et al, 2007;Lacey, Ellen, Devlin, Wright, & Mijch, 2007;Merchant, et al, 2014;Merchant, DeLong, Liu, & Baird, 2015;Rosenberg, et al, 2010;Roux, et al, 2016); and dried blood spot testing (Hickman, et al, 2008;Radley, et al, 2017). Interventions to enhance linkage to care included facilitated referral for HCV assessment and scheduling of specialist appointments for clients (Cullen, et al, 2006;Masson, et al, 2013;Tait, McIntyre, McLeod, Nathwani, & Dillon, 2010).…”

Role of community‐based research in advocating HCV prevention and care

“…One such existing intervention, called AERLI, was community-based and focused on reducing injection-related harm. Conducted by peers and other health staff, it was based on two nested phases: the use of a standardized checklist when supervising injection and a tailored intervention to reduce harm which included information about hepatitis C testing and treatment.The ANRS AERLI study showed a significant reduction in HCV risk practices and an increase in HCV testing in the intervention group [4,5]. The importance of these results led AERLI to be included as a novel prevention intervention in the new 2016 French health law.…”

“…The ANRS AERLI study showed a significant reduction in HCV risk practices and an increase in HCV testing in the intervention group [4,5]. The importance of these results led AERLI to be included as a novel prevention intervention in the new 2016 French health law.…”

“…Community-based research is very effective as its arguments to endorse social transformations are based on real-world evidence.There are several important examples of how communitybased research has contributed to change health policy in France. These include ANRS DRAG, which promoted community-based testing as a tool to attract most-at-risk groups [2], ANRS Ipergay, which showed the effectiveness of on-demand HIV pre-exposure prophylaxis on HIV incidence in MSM [3], and ANRS AERLI, which evaluated the effectiveness of an existing educational intervention entitled AERLI for HIV and HCV prevention in PWID [4,5].More specifically, ANRS AERLI was implemented through a collaboration between the French National Institute of Health and Medical research (INSERM) and two community-based associations AIDES and MDM, to respond to a specific public health need which was to identify and evaluate innovative harm reduction and HCV preventive interventions. One such existing intervention, called AERLI, was community-based and focused on reducing injection-related harm.…”

“…There are several important examples of how communitybased research has contributed to change health policy in France. These include ANRS DRAG, which promoted community-based testing as a tool to attract most-at-risk groups [2], ANRS Ipergay, which showed the effectiveness of on-demand HIV pre-exposure prophylaxis on HIV incidence in MSM [3], and ANRS AERLI, which evaluated the effectiveness of an existing educational intervention entitled AERLI for HIV and HCV prevention in PWID [4,5].…”