In 2016, the World Health Organization (WHO) set an ambitious goal to eliminate hepatitis C as a major public health threat by 2030 1. Specific targets include increasing sterile needles/syringes distributed from 20 to 200 per person per year for PWID, reducing new hepatitis C infections by 80% and hepatitis C‐related deaths by 65%, increasing hepatitis C diagnoses from <20% to 90% and the number of people receiving hepatitis C treatment from less 10% to 80%. Drug injection was main contamination route of hepatitis C virus (HCV) in France and western Europe since 1990 2. Although highest European HCV screening rate in France, 33% of patients didn’t take care of hepatitis C because there were no diagnosed 3. On 2018, the International Network of Hepatitis in Substance Users (INHSU) published recommendations for good practices about HCV pathway on drug users 4. There were detailed on Table 1.

From 2016 French guidelines 5 were to treat all inmates and drug users, even fibrosis level with direct antiviral agents (DAA). Success rate of DAA, one or tow pills per day for 8 or 12 weeks therapy, was 95 to 97%. Before that, access of HCV screening, care and treatment in drugs users, prisoners and homeless was low in France. They were considered as difficult to treat populations. All these patients need support especially psycho-educative interventions. The Mobile Hepatitis Team (MHT was set up in 2013, following the publication of an scientific report on reducing risks of infection amongst drugs users in 2011 1, which recommends screening all drug users for HCV and establishing multidisciplinary clinics with ‘all-in-one’ screening to treatment and providing medical and social care.

Our main objective was to increase outreach screening care treatment access and cure of our target population. Target population was drugs users, prisoners, homeless, precarious people, migrants and psychiatric patients. It was not phase IV study and we don’t need any IRB or specific authorization. HMT was composed of 1 hepatologist, 3 nurses, 1 secretary, 2 social workers, one health care worker, for a cross-disciplinary approach. Resources include two specific cars, on van, serology point-of-care testing (POCT), and two mobile FIBROSCAN®. Forty two different medical and social units were partners: low and high threshold drug units, retention and detention center medical units, outside psychiatric units, emergency and homeless food/hosting units. We proposed part or all of our services to our medical and social partners. There were 15 services for half million people area in south of France. All services were free for patients and for partners. Services were organized in 4 sucessive steps:

From 2013 July to 2018 December, MHT met 5382 people (Figure 1). Eighty eight per cent of people are drugs users or former drug users; 97% are precarious. MHT did 8382 DBS of whom 3053 HCV DBS and 2302 Fibroscan*. HCV new positive serology rate was 21.3%. With addition of known HCV patients and after HCV viral load measure, our active file was 651 patients included these new patients screened by DBS. Main sites of patients screening were outdoor sites (Green Thread), prison and drug users units (Figure 2).

Ninety eight per cent of HCV serology positive patients realized all blood tests and FIBROSCAN. DAA treatment was proposed par PTC to 96% of them; 95% started DAA treatment, 2% were lost follow up and 3% refused treatment. After treatment, there were 7 relapsers and 3 reinfections by drug injection. Our cured rate was 94%. A total of 359 people have received psychoeducative interventions. Sociological evaluation of our project showed that 4 program main qualities for patients were free access, closeness (outside hospital), speed (of the results) and availability (of nurse and social workers).

Specific follow-up of drugs users and other HCV high-risk patients including screening, early detection, diagnosis and treatment increase rate of treated and cured patients, with low rate of relapse and new infections. MHT offers ‘all-in-one’ care for drug users and vulnerable people with HCV, using outside social and medical teams. MHT was partnered with organizations including hospital services, psychiatric units, non-hospital organizations such as drug services, and the associative section such as patient associations and a hepatitis network.

Highlights of the model included rapid DAA initiation of diagnostic procedures after first contact rapid specialist consultation as needed, within 72 hours, an easy link between outside structures and hospital (with a date of appointment and orientation hospital partners) coverage over a wide geographical and socially disadvantaged area with a territory of almost 500,000 people, a telephoneinterpreting service to enable treatment of people who do not speak French. In conclusion, with invested teams and adherence to the project, use of a MHT could increase the number of drug users and vulnerable people with HCV who are supported, treated and cured. Next step was to develop test to cure sessions like in Australia 78 to create HCV pathway simplification (Figure 3).

There was too many under diagnosed HCV patients, especially in homeless, prisoners and drugs users 9.