HepCare Europe: a service innovation project. HepCheck: enhancing HCV identification and linkage to care for vulnerable populations through intensified outreach screening. A prospective multisite feasibility study

Abstract

Objectives Hepatitis C is one of the main causes of chronic liver diseases worldwide. One of the major barriers to effecting EU- and WHO-mandated HCV elimination by 2030 is underdiagnosis. Community-based screening strategies have been identified as important components of HCV models of care. HepCheck Europe is a large-scale intensified screening initiative aimed at enhancing identification of HCV infection among vulnerable populations and linkage to care. Methods Research teams across four European countries were engaged in the study and rolled out screening to high-risk populations in community addiction, homeless and prison services. Screening was offered to 2822 individuals and included a self-administered questionnaire, HCV antibody and RNA testing, liver fibrosis assessment and referral to specialist services. Results There was a 74% (n=2079) uptake of screening. The majority (85.8%, n=1783) were male. In total 44.6% (n=927) of the sample reported ever injecting drugs, 38.4% (n=799) reported ever being homeless and 27.9% (n=581) were prisoners. In total 397 (19%) active HCV infections were identified and 136 (7% of total sample and 34% of identified active infections) were new cases. Of those identified with active HCV infection, 80% were linked to care, which included liver fibrosis assessment and referral to specialist services. Conclusions HepCheck’s screening and linkage to care is a clear strategy for reaching high-risk populations, including those at highest risk of transmission who are not accessing any type of care in the community. Elimination of HCV in the EU will only be achieved by such innovative, patient-centred approaches.

Hepatitis C screening and referral for further investigation and treatment in a tertiary care hospital

“…They suggest that the elimination of HCV will only be possible with such patient-centered approaches. The HepCheck model provides a template for HCV screening that could be introduced in many countries in accordance with local healthcare systems and resources [23].…”

We know DAAs work, so now what? Simplifying models of care to enhance the hepatitis C cascade

“…Amongst PWID and other vulnerable populations, rapid testing has been shown to substantially increase coverage and referral rates . To date, many services have not been developed for vulnerable populations such as the homeless, PWID and prisoners, which must both contend with numerous social determinants that contribute to poor quality of life and poor social functioning as well as health inequalities . It should be emphasized that HCV treatment should be offered based on clinical rather than social factors or injecting‐related behaviours , underlining the necessity of overcoming obstacles to HCV treatment delivery to PWID.…”

Identification and treatment of viral hepatitis C in persons who use drugs: a prospective, multicenter outreach study in Flanders, Belgium

“…A review concerning HCV in American homeless people shows an HCV Ab prevalence ranging from 23 to 39% [ 35 ]. In a study by Barror et al [ 19 ] in high-risk populations (community addiction, homeless, and prison services) in Ireland, the UK, Romania, and Spain, an HCV Ab prevalence of 37.0% was found. This is slightly higher than our findings and can be explained by the fact that in the study of Barror et al [ 19 ], the proportion that ever injected drugs was higher (44.6%) than in our study population (34.8%).…”

“…There are no good estimates of the size of these subgroups in Europe, which are often completely isolated from care. Nevertheless, outreach methods to contact vulnerable populations have been proven successful in different European countries and Australia [19][20][21][22][23]. We aimed to reach out to this specific and vulnerable PWUD community not reached within the OAT program of a community-based facility using a non-invasive screening method.…”