Lorenzo Magenta, Elena Fossati, Benedetta Terziroli, Vanina Gurtner, Andreas Cerny

Results of an educational and screening program for liver diseases in patients attending substance use rehabilitation programs in southern Switzer- land

Liver Clinic, Clinica Luganese Moncucco, Lugano, Switzerland

Background and aims: Substance users are at high risk of viral (HBV and HCV) and alcoholic liver disease leading in some to progressive fibrosis and cirrhosis. Users in rehabilitation pro- grams often lack information about health risks related to subs- tance use and ways for prevention and treatment and often postpone medical workup and treatment. The aims: 1. To im- prove knowledge about epidemiology, mode of acquisition, natural history, diagnosis and treatment of chronic HBV and HCV hepatitis in persons participating in substance use rehabili- tation programs in southern Switzerland. 2. To identify users with liver disease and fibrosis or cirrhosis using ALT and Fibro- scan® testing. 3. To offer personalized counseling on diagnostic workup and treatment for persons with significant fibrosis or cirrhosis in order to prevent progression to cirrhosis and its complications.

Methods: Substance use rehabilitation programs were offered an educational event, held by an MD, with information on epi- demiology, mode of acquisition, natural history, diagnosis and treatment of chronic HBV and HCV hepatitis. Participants interested were given the possibility to undergo ALT-testing, Fibroscan® testing as well a consultation with a physician, free of charge.

Results: Eleven institutions were involved, 7 offering residential and 4 daytime rehabilitation programs. A total of 143 users and 24 health care workers attended the educational sessions. 82 of whom (57.3%) participated in the ALT/Fibroscan screen- ing program. The mean age was 43.9 years (65 male and 17 female). 17.8% had normal liver elasticity, 60.3% had abnor- mal values compatible with fibrosis assessed by Fibroscan (> 4.0 KPa). 10.9% had at least moderate (F2-F4) fibrosis (> 8.0 KPa) and 10.9% had values indicating cirrhosis (>16 KPa, F4).

Conclusions: The results confirm a high burden of liver disease in substance users in rehabilitation programs in our region. The interest to the program was excellent with 57.3% of those

participating in the educational event undergoing voluntary ALT and Fibroscan® testing followed by counseling. Significant liver disease was found in more than 4/5 of the participants. More than 10% had results compatible with cirrhosis.

Acknowledgements: Supported by Infodrog, G. Merlani MD (Can- tonal Officer of health), Roche Pharma, Merck Sharp&Dohme, Gilead Sciences and Novartis Pharma.