HCV micro-elimination: holistic approach to care in people who inject drugs

This story is the first in a series highlighting what hepatitis C micro-elimination looks like around the world. We’re zooming in on projects in different countries to showcase the learnings, the challenges and the successes in the relentless pursuit to eliminate hepatitis C.

When Christoph Hagenlocher first met Stefanie, a woman who used intravenous drugs, she was at rock bottom. As they ate lunch together in a drug treatment center in Stuttgart, Germany, back in 2014, Stefanie opened up about the challenges she was facing. She was addicted to heroin. Her daughter wouldn’t speak to her. She was homeless. Also, she had hepatitis C.

At the time, Hagenlocher, a health economist with AbbVie Germany, was travelling the country to speak with patients and care providers, searching for a solution to the public health challenge of treating  hepatitis C in people who inject drugs. As he listened to Stefanie, he heard a familiar story. She, like so many other patients, was mired in a web of other social, economic and health challenges, so it was hard for her to focus on treating the disease.

He realized only treating the infectious liver disease in patients like Stefanie wasn’t enough – but he was beginning to form an idea of what might be.

“It became clear to me that we’re going to have to do something special to help people who inject drugs at critical points in their lives so that they could one day prioritize their hepatitis C treatment,” Hagenlocher says.

Years later, with support from many different individuals and community organizations across Stuttgart, Stefanie found a path forward. She joined a newly formed, multi-layered support network, called Project PLUS, got help with her addiction, built social support, and found a place to live.

Then, now that she was ready, she got help to treat her hepatitis C.
 

An estimated 71 million people worldwide are infected with the hepatitis C virus.¹ Intravenous drug use is a major risk factor for infection,¹ but people who inject drugs often feel uncomfortable seeking medical care or are focused on other priorities, such as overcoming addiction or finding a job, Hagenlocher says.

To understand the challenges of treating hepatitis C in people who inject drugs, Hagenlocher shadowed workers at Caritas, a charity in Stuttgart that helps people overcome drug addictions. Caritas is a daily destination not only for help with addiction, but also to receive assistance with job applications, take cooking classes, play sports, and watch movies. These everyday activities help provide structure and routine, so that clients like Stefanie have time to think about other challenges they want to tackle, such as hepatitis C.

But Hagenlocher realized that once people were ready to address their infection, there were only a few counselors who could engage with patients in places like Caritas or in the streets, and just as few health care providers who were trained to treat hepatitis C in people with addiction disease.

Then came the second light-bulb moment: There was a need for a more engaged referral network between counselors and treaters. Hagenlocher got to work again.
 

Project PLUS was implemented in additional cities as a referral network that would connect counselors with engaged health care providers who were willing and able to provide treatment for marginalized people with hepatitis C.

In Ludwigshafen, Project PLUS helped health care providers know where to send patients for treatment and what diagnostic procedures to perform, something providers previously had to figure out on their own.

One of those providers is Jörg Fränznik, a social worker who interacts with people outside of treatment centers. He credits Project Plus with creating a sustainable support system that has replaced previous, temporary projects. 

“Thanks to this initiative, I have a better relationship with other partners who provide support, because we have worked together on this common cause. This is a real improvement and relief,” he says. 

Physician Petra Pflaum is part of the referral network through her community-based practice in Ludwigshafen. “Treating my HCV-infected patients was quite a challenge before Project PLUS, as there was no structure or network and I didn’t know enough about the therapy,” she says. “I can now treat my patients in a more effective and comprehensive way, which is a great feeling.”

Since 2018, the project has expanded to eight cities, with negotiations underway to expand to another eight, Hagenlocher said. Project PLUS began with the potential to help 1,000 patients. Now, he says, it has the potential to reach 28,000.

Stefanie was one of the first people to embark on the road to recovery with Project PLUS, and she is now free of hepatitis C. She has a job, a good relationship with her daughter, and her own apartment.

Recently, when Project PLUS held a big event to rally support for their work, she climbed the podium, told her story and thanked the network, hoping to inspire people who suffer from addiction to get care – and, just as importantly, to inspire others to help provide care.

“She is our role model,” Hagenlocher says. “It’s really quite emotional when you see patients that you met just a few years ago when they were struggling, and you see how powerful they are now.”

As good as it feels to help people like Stefanie, Hagenlocher is looking toward a future when projects and events like these are no longer needed.

“Our main objective is that the pillars we have developed will be incorporated into normal care delivery,” he says. “We want to bring these learnings into the standard of care so that Project PLUS is no longer necessary.”

Project PLUS is one example of a new concept, called micro-elimination, which has gained momentum for its potential to break down the societal barriers that make elimination difficult. AbbVie supports an estimated 300 micro-elimination projects globally in hopes of learning from what works and replicating that success elsewhere to help meet the 2030 elimination goal.
 

David Freundel
Email: david.freundel@abbvie.com
Call: + 1 847-937-4522

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