Good practice examples
FRANCE – Gaia
Treatment-on-site; mobile-HCV-testing-and-elastography; drug-consumption-room;
TEST; LINK; TREAT-int-ext ; LTA; OUT; PWUD+ ; PEER; NURSE; MULTI;
Where – Services provided:
low-threshold drug service and counselling; needle and syringe exchange; opioid substitution therapy (OST); drug consumption room (DCR); outreach/street-work; mobile unit; prison work.
Who – Target groups:
people who use drugs (PWUD) or inject drugs (PWID); sex workers; homeless; (un)documented migrants.
How – Team composition:
social workers; peer workers (paid and volunteer); medical doctors; nurses; hepatologist; art therapist; security guard.
Gaia is a harm reduction service provider based in Paris, France. Their facilities welcome all populations including people who use drugs, the homeless, sex workers, documented or undocumented migrants, and people in other precarious situations. The programme started at the beginning of the 1990’s as part of the NGO ’Doctors of the World’ and became independent in 2005. A quarter of their clients come from Eastern Europe and there has been an increase in clients coming from India.
In 2011, Gaia was the first organization in Paris to use a mobile Fibroscan; the mobile unit, and the low-threshold drug service, started offering rapid HCV testing in 2013.
Awareness & Prevention
Gaia organises HCV and HIV testing weeks in its different services and a specific HCV testing week in at its drug consumption room (DCR) three times per year.
They have informative handouts but, due to the large number of clients, they face difficulties in reaching everyone. They also provide counselling on hepatitis-related issues and organise internal and external education sessions, workshops and trainings for staff as well as clients and their partners.
Some of Gaia’s previous clients have become staff members and volunteer peers. However, peer involvement is now active in supporting the DCR rather than HCV activities.
Community-based testing without a medical doctor or qualified nurse is allowed in France. Through all Gaia services (mobile unit, DCR, OST), clients can benefit from Fibroscan testing, HCV, HBV and HIV rapid blood tests. Dried blood spot is performed by a professional when a rapid test is positive with the results communicated to the client by a doctor.
After being trained in advance by its medical staff, the Gaia team performs testing by themselves and are also helped by partners who prepare clients in advance (e.g. information about HCV, HBV). A special mandatory training is required by the authorities for performing such rapid tests.
Staff are regularly tested for HCV and HBV extern to Gaia and are offered vaccinations for hepatitis A and B.
Treatment & Care
Treatment can be administrated both externally and on site (at the DCR or at the low-threshold OST unit). Gaia offers disease self-management support and liver health monitoring/assessment. Overall, there is no specific protocol used for pre- and post-test counselling as mandatory training is required by the authorities and all staff are trained externally or internally in counselling skills.
Although more than 10 hepatologist hospital services have been mobilised by regional health authorities under a ‘HCV Cascade of Care’ programme, the cascade of care only functions well if a client has access to social security services. Consequently, Gaia has staff who primarily help clients to gain access to such social services.
The main challenge facing Gaia is funding. For example, if a client tests positive from a rapid test, it is important to confirm the result with a RNA test which is not easy to access.
To reduce the long waiting times between testing and receiving test results, Gaia’s nurse who is assigned to its mobile unit is part of a medical network in the vicinity of the partner premises that supports the delivery of the test result to the client and their linkage to care, such as a local hepatologist or local hospital. Currently, Gaia is seeking authorisation to implement a Test & Treat service.
Advocacy, Sustainability and Transferability
Gaia is not directly involved in advocacy as such, but rather through its partners. However, they do participate in daily meetings with important governmental stakeholders concerning political and financial support, both of which are currently insufficient.
In terms of monitoring and evaluation, Gaia has put in place software to register clients. Registration is based on the surname of the client and their date of birth as well as health-related information, including HCV, HIV, HBV testing. The database is not accessible to other organisations or actors; however, an annual report is sent to local health stakeholders. Qualitative studies of Gaia services, cooperation, etc., are conducted as part of evaluation activities.
Gaia’s strength comes from their ability to involve many different partners together to fight the same problem with common resources. Rather than having competitive relationships with a limited budget, Gaia has a collaborative approach through the sharing of information and knowledge and in conducting common trainings that tackle common problems, all of which improves the cascade of care and makes services more accessible for clients.
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