Eliminating hepatitis C on the Balearic Islands, Spain: a protocol for an intervention study to test and link people who use drugs to treatment and care

Abstract

IntroductionThe hepatitis C virus (HCV) is a highly infectious and deadly disease, affecting some 58 million people worldwide. Of the 1.13 million people living in the Balearic Islands, Spain, about 1350 individuals have untreated HCV. Of these, about 1120 (83%) are estimated to be people who use drugs (PWUD), who are one of the key at-risk groups for HCV infection globally. Carrying out micro-elimination approaches focused on this population is crucial to achieve the WHO goal of eliminating HCV by 2030. Thus, the primary objective of this study is to validate a model of care that simplifies the screening and linkage to HCV care pathways for PWUD on the Balearic Islands.Methods and analysisThis intervention study will be implemented across 17 sites, in 4 different settings: addiction service centres (n=12), non-governmental organisation centres (n=3), a mobile methadone unit and a prison, with an estimated 3725 participants. Together with the healthcare staff at each centre, the intervention protocols will be adapted, focusing on four phases: recruitment and testing; linkage to care; treatment for those who test positive; and monitoring of sustained virological response 12 weeks after treatment and reinfection. The primary outcomes will be the number of tested and treated individuals and the secondary outcomes will include individuals lost at each step in the cascade of care. Descriptive analysis and multivariable logistic regression of the data will be undertaken.Ethics and disseminationThe Hospital Clínic Barcelona, Spain, Ethics Committee approved this study on 18 February 2021 (HCB/2020/2018). Findings will be disseminated through peer-reviewed publications, conference presentations and social media. The results of this study could provide a model for targeting PWUD for HCV testing and treatment in the rest of Spain and in other settings, helping to achieve the WHO HCV elimination goal.

Assessing the rate of non‐linkage to care and identifying barriers in individuals living with hepatitis B. Results of the LINK‐B study

“…8 Because of these efforts, at least nine high-income countries are now on track to achieve the WHO hepatitis C goals by 2030. 9 However, the scenario for hepatitis B is less favourable. 10 Recent estimations predict that none of the participating countries will eliminate hepatitis B by this time point, a fact that highlights the importance of implementing strategies similar to those used in hepatitis C. 11,12 One proposed intervention is active searching for people with undiagnosed HBV infection and simplifying access to care.…”

“…In recent years, several strategies have been developed for this purpose, such as national plans against hepatitis C, with micro‐elimination approaches focused on high‐risk populations 8 . Because of these efforts, at least nine high‐income countries are now on track to achieve the WHO hepatitis C goals by 2030 9 . However, the scenario for hepatitis B is less favourable 10 .…”