A peer-led recruitment strategy proved highly successful in
engaging people who use drugs in testing and treatment for hepatitis C in the
French city of Montpellier, researchers from the University of Montpellier
report in the journal Open Forum Infectious Diseases.
They say their strategy has the potential to engage people
who use drugs who are harder to reach and not in touch with drugs services or
physicians. The peer recruitment strategy reached approximately one-third of
people who use drugs in Montpellier within three months and identified 49
people eligible for hepatitis C treatment.
Hepatitis C treatment is just as effective in people who use
drugs as in other people with hepatitis C, but lack of engagement with medical
services has proved a barrier to hepatitis C elimination in people who use
A non-invasive test, used instead of a biopsy, to measure the stiffness
or elasticity of the liver using an ultrasound probe.
The French study was designed to investigate the use of
peer-led recruitment for testing and treatment. Peer-led recruitment may build
trust in healthcare interventions and reach people who would otherwise be
overlooked for the offer of testing.
The study was open to anyone who had used drugs apart from
cannabis in the past three days and did so at least ten times a month.
Recruitment was not restricted to opiate users.
Study recruitment began by identifying 15 people who use
drugs with distinctive non-overlapping characteristics, including gender, age,
sex work, drug-using and sexual behaviours and district of residence. To be
recruited as a study ‘seed’, participants were required to have a network of at
least five people who use drugs. Each ‘seed’ was given three tokens to
distribute to other drug users and those who received the tokens were required
to present them at the study site to receive free testing and counselling.
After joining the study, the new participants were each given three tokens to
distribute to their own contacts.
Study ‘seeds’ and participants received 20 euros for each
token returned and also received 50 euros to cover travel costs and time spent
at the study site.
Study participants attended for testing and counselling at a
study site located near the university hospital. Study participants gave a
urine sample to check for recent drug use and then gave blood samples for HIV, hepatitis
B and hepatitis C rapid antibody tests. Anyone who tested positive for HCV
antibodies underwent onsite HCV viral load testing and Fibroscan evaluation for
Those diagnosed with chronic hepatitis C were able to
discuss treatment with an on-site physician, receive a prescription and be accompanied
to a pharmacy by a peer volunteer to pick up their medication. It was not possible
to deliver medication onsite under French law. People lacking health insurance
received assistance from a social worker to obtain coverage before they could
The study recruited 634 potential participants in a
three-month period in late 2020, of which 554 were eligible to participate.
Most participants were male (78%) with a median age of 39. Sixty-two per cent
were living on social benefits. Thirty-two per cent tested positive for
hepatitis C antibodies and 49 had detectable hepatitis RNA (8.8%) and were
eligible for treatment.
Thirty-seven people started treatment, 30 completed treatment
and 27 (73%) had a sustained virologic response 12 weeks after completing
treatment. Of those who did not have a sustained virologic response, one was
lost to follow-up. Sixty per cent of those who were treated did not start
treatment during the survey period, but all except one were treated within six
months of diagnosis.
Based on previous research into the size of Montpellier’s
drug-using population, the study investigators estimate that the intervention
reached one-third of the city’s drug users in three months. They say that the
respondent-driven sampling method they used for recruitment is probably more
effective than peer outreach because it has the potential to reach a wider
range of networks.
Economic analysis showed that it cost 1816 euros to reach
each person with chronic hepatitis C and 33,878 euros per cured patient.