Differences in the hepatitis C virus cascade of care and time to initiation of therapy among vulnerable subpopulations using a mobile unit as point‐of‐care

Abstract

Background and Aims: People who inject drugs (PWID) and other marginalized populations with high hepatitis C virus (HCV) infection rates represent a unique challenge for treatment initiation due to health, administrative and social barriers. We analysed the HCV cascade of care (CoC) in some vulnerable subpopulations in Madrid, Spain, when using a mobile point-of-care (PoC).Methods: From 2019 to 2021, a mobile unit was used to screen active HCV using a linkage-to-care and two-step PoC-based strategy. Viremic participants were grouped into four subgroups: PWID, homeless individuals and people with a mental health disorder (MHD) and alcohol use disorder (AUD). Logistic regression, and Cox and Aalen's additive models were used to analyse associated factors and differences between groups.Results: A prospectively recruited cohort of 214 HCV-infected individuals (73 PWID, 141 homeless, 57 with a MHD and 91 with AUD) participated in the study. The overall HCV CoC analysis found that 178 (83.1%) attended a hospital, 164 (76.6%) initiated direct-acting antiviral therapy and 141 (65.8%) completed therapy, of which 99 (95.2%) achieved sustained virological response (SVR). PWID were significantly less likely to initiate treatment, whereas individuals with AUD waited longer before starting the treatment. Both people with AUD and PWID were significantly less likely to complete HCV treatment.Conclusions: Overall, SVR was achieved in the majority of the participants treated.However, PWID need better linkage to care and treatment, whereas PWID and AUD need more support for treatment completion. K E Y W O R D S cascade of care, hepatitis C virus, marginalized populations, model of care, point-of-care test How to cite this article: Valencia J, Lazarus JV, Ceballos FC, et al. Differences in the hepatitis C virus cascade of care and time to initiation of therapy among vulnerable subpopulations using a mobile unit as point-of-care.

Peer support in small towns: A decentralized mobile Hepatitis C virus clinic for people who inject drugs

“…This finding is not surprising and consistent with the broader HCV literature among PWID where rates of loss to follow‐up or DAA treatment discontinuation have been reported in 5%–10% 11,16,47 . Treatment uptake was also higher than reported from mobile HCV clinics in Brisbane, Copenhagen and Madrid 32,35,37 . Despite being similar mobile units, these studies were conducted in urban settings and did not integrate peer support with POC testing and treatment initiation without additional specialist consultation.…”

“…11,16,47 Treatment uptake was also higher than reported from mobile HCV clinics in Brisbane, Copenhagen and Madrid. 32,35,37 Despite being similar mobile units, these studies were conducted in urban settings and did not integrate peer support with POC testing and treatment initiation without additional specialist consultation.…”

“…[27][28][29][30] Promising outcomes have been reported following POC testing in community-based services, including needle and syringe programs, pop-up clinics, mobile harm reduction units and community pharmacies. [31][32][33][34][35][36][37] Although there are examples of successful mobile HCV clinics, 32,35,37 they have been conducted in typical urban settings, and few have combined POC testing with peer support.…”

“…Promising outcomes have been reported following POC testing in community‐based services, including needle and syringe programs, pop‐up clinics, mobile harm reduction units and community pharmacies 31–37 . Although there are examples of successful mobile HCV clinics, 32,35,37 they have been conducted in typical urban settings, and few have combined POC testing with peer support. To our knowledge, this is the first study reporting on the effectiveness of a peer‐driven mobile HCV clinic providing services in small towns, integrating POC HCV RNA testing, liver disease staging and treatment initiation in a one‐step process facilitated by peer support.…”

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

“…Stable housing reduces the risk of HCV transmission [ 27 ] and removes stressors to allow people to prioritise health and wellbeing [ 28 ]. Some interventions have attempted to mitigate the effects of homelessness with regards to treatment uptake, by providing flexible appointments [ 26 ] or mobile testing and treatment [ 29 ]. A mobile unit employing a same day ‘test and treat’ model for a cohort in which the majority were experiencing homelessness, reported 77% initiating treatment [ 30 ].…”