A Testing Campaign Intervention Consisting of Peer-Facilitated Engagement, Point-of-Care HCV RNA Testing, and Linkage to Nursing Support to Enhance Hepatitis C Treatment Uptake among People Who Inject Drugs: The ETHOS Engage Study

Abstract

This study evaluated HCV treatment initiation among people who inject drugs (PWID) following an intervention of campaign days involving peer connection, point-of-care HCV RNA testing, and linkage to nursing support. ETHOS Engage is an observational cohort study of PWID attending 25 drug treatment clinics and needle and syringe programs in Australia (May 2018–September 2019). Point-of-care results were provided to the nurse, facilitating confirmatory testing and treatment. The study aimed to evaluate treatment uptake and factors associated with treatment at 24 months post-enrolment. There were 317 people with current HCV infection and eligible for treatment (median age 43, 65% male, 15% homeless, 69% receiving opioid agonist treatment, 70% injected in last month). Overall, 15% (47/317), 27% (85/317), 38% (120/317), and 49% (155/317) of people with current HCV infection had initiated treatment at 3-, 6-, 12-, and 24-months following testing, respectively. Homelessness (adjusted hazard ratio (aHR): 0.40; 95% confidence interval: 0.23, 0.71) and incarceration in the past 12 months (vs. never, aHR:0.46; 0.28, 0.76) were associated with decreased treatment initiation in the 24 months post-enrolment. This testing campaign intervention facilitated HCV treatment uptake among PWID. Further interventions are needed to achieve HCV elimination among people experiencing homelessness or incarceration.

Community-Based Point-of-Diagnosis Hepatitis C Treatment for Marginalized Populations

“…Sixty-seven percent of the ITT group participants and 84% of the PP group participants achieved SVR12. These proportions are consistent with other treatment trials, 35 , 36 , 37 demonstrating that once enrolled, PWID can successfully complete treatment and achieve SVR. In the HERO (Patient-Centered Models of HCV Care for People Who Inject Drugs) study, 755 PWID recruited at opioid treatment programs and community health centers were randomized to receive HCV treatment with patient navigation vs modified directly observed therapy.…”

“…Indeed, treatment acceptability and adherence were also high as measured by the proportion of eligible participants who started and completed treatment. Treatment initiation was more common in the NOW study model, and point-of-diagnosis treatment was tolerated and safe, with no deaths or other serious adverse events.…”

Viral hepatitis testing and treatment in community pharmacies: a systematic review and meta-analysis

“…Pharmacies are an important and acceptable setting for hepatitis C testing. The high pooled proportion antibody positive of 17.4%, and proportions RNA positive ranging from 2.0% to 37.5% are similar to those seen in studies of other community settings with high-risk populations, including addiction treatment centres, 51 supervised drug consumption services, 52 NSPs, 51 , 53 and community correctional services. 54 Recruiting participants for testing by only targeting people with a specified risk factor, such as people on OAT or people accessing NSP services, produced an even higher pooled proportion antibody positive (32.5%).…”

CHIME - A tailored HCV microelimination project in Viennese people who inject drugs at drug centralized substitution centers

“… 1 , 2 , 3 , 4 While in some high-incidence populations, such as men-who-have-sex-with-men (MSM), the implementation of HCV elimination programs has led to a significant increase in successful HCV cure, comprehensive screening/diagnostic testing and linkage to care represent a major challenge in other difficult-to-reach populations such as people experiencing homelessness, those who are incarcerated and people who inject drugs (PWIDs). 5 , 6 , 7 , 8 …”

“… 10 Therefore, tailored HCV elimination efforts focusing on these unmet needs of PWIDs are needed to overcome specific barriers in the cascade to HCV cure. 5 , 11 , 12 …”