Efficacy of a comprehensive strategy for the detection and treatment of hepatitis C infection in a population attending addiction centers

Abstract

Background and aimsThe burden hepatitis C infection in people with history or current drug use suppose a high risk of hepatic complications and transmission infectious disease. This population is poor linked to heath system and is difficult to achieve them and support treatment because they have high rates of lost follow-up. Our aim was to evaluate an intervention for the diagnosis and treatment of chronic hepatitis C and HIV in this population.MethodsSix-hundred and eighty-three people attended in Drugs and Addictions Centers (DAC) were asked to participate in health counseling and provide blood sample for test HCV, HIV, and syphilis from April 2019 to June 2020. Totally 556 subjects were surveyed and tested. All of them were assigned to a patient navigation program to improve health education and linking to the sanitary system. Hepatitis C infection patients were evaluated in an ampliated medical consult to evaluate hepatic stage with transient liver elastography and initiated Direct Acting Antivirals to achieve Sustained Viral Response.ResultsOf the 556 patients who agreed to participate in the study, 33 (5.9%) had active HCV infection. Of the 33 patients infected with HCV, three were lost to follow-up once the diagnosis of HCV infection was made. Twenty-eight patients (93.3%) completed treatment and 26 achieved Sustained Viral Response (78.8%). Of the 30 patients, seven (23.3%) had advanced fibrosis, and of these, four (16.6%) had liver cirrhosis. One of the cirrhotic patients had hepatic space-occupying lesions at the baseline evaluation and was diagnosed with hepatocarcinoma.ConclusionsOur study suggests that the implementation of strategies based on personalized intervention models can contribute to the control of HCV infection in DAC users.

Hepatitis C virus point-of-care microelimination approach in a vulnerable population in the South of Spain

“…In our study, males predominated among the screened vulnerable population, especially among viremic patients, similarly to what has been seen in other Spanish studies [ 23 , 25 ]. This is probably related to more risk-associated habits among men, such as illicit drug use.…”

“…The prevalence of HCV-infected participants in our study conducted in the South of Spain was 10%, which increased to 20% if only participants from drug addiction treatment centers are considered. These prevalences are higher than what is estimated in the general Spanish population (0.22%) [ 8 ] or other drug addiction treatment centers in Southern Spain (6%) [ 23 ], but lower than reported in a recent study on people who inject drugs in Northern Spain (56%) [ 24 , 25 ]. Despite differences in infection rates, these data confirm that drug users and homeless people are vulnerable to HCV infection and should be considered crucial targets for specific screening and HCV microelimination programs.…”

“…In fact, active drug users had worse results with “standard of care” treatment and higher benefits of HCV microelimination programs in “test and treat at the point-of-care” [ 25 ]. Other strategies in vulnerable populations involving an education program and a liaising nurse facilitating HCV evaluation and treatment in a single consultation have achieved a high rate of treatment (93.3%) and SVR (78.8%) [ 23 ]. In addition to the measures taken in the previous study, in the present study, we used a simplified blood collection tool, the DDT, which could potentially be more acceptable to many persons than a vein blood extraction; this needs to be confirmed in further studies.…”

“…Other risk-associated habits, such as consumption of alcohol and tobacco use, were also frequent in the screened population, especially in HCV patients. Higher prevalence of alcohol consumption has been described in epidemiological studies in HCV-infected patients [ 23 , 28 ]. This highlights the need for healthcare professionals to target populations with risk-associated habits due to the increased risk of comorbidities, such as infections (HCV, HBV, HIV) or psychiatric disorders, among others [ 10 , 11 , 29 , 30 ].…”

Comparison of hepatitis B and SARS-CoV2 vaccination rates in people who attended Drugs and Addiction Centres

“…The study subjects had previously participated in a study evaluating a comprehensive strategy for detecting and treating hepatitis C infection in Cordoba ( 10 ). The healthy volunteers were included in the present study.…”