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

Abstract

Background Targeted screening for hepatitis C viral (HCV) infection is not yet widely executed in Belgium. When performed in people who use drugs (PWUD), it is mainly focused on those receiving opiate agonist therapy (OAT). We wanted to reach out to a population of difficult to reach PWUD not on centralized OAT, using non-invasive screening as a bridge to re-integration in medical care supported by facilitated referral to a specialist. Methods This was a prospective, multicenter cohort study in PWUD not enrolled in a centralized OAT program in a community-based facility in Limburg or OAT program in a community-based facility in Antwerp, Belgium, from October 2018 until October 2019. Two study teams recruited participants using an outreach method at 18 different locations. Participants were tested for HCV antibodies (Ab) by finger prick, and risk factors were assessed through a face-to-face questionnaire. Univariate analyses were used to assess the association between HCV Ab and each risk factor separately. A generalized linear mixed model was used to investigate the association between the different risk factors and HCV. Results In total, 425 PWUD were reached with a mean age of 41.6 ± 10.8, and 78.8% (335/425) were men. HCV Ab prevalence was 14.8% (63/425). Fifty-six (88.9%) PWUD were referred, of whom 37 (66.1%) were linked to care and tested for HCV RNA. Twenty-nine (78.4%) had a chronic HCV infection. Treatment was initiated in 17 (58.6%) patients. The adjusted odds for HCV Ab were highest in those with unstable housing 6 months before inclusion (p < .001, AOR 8.2 CI 95% 3.2–23.3) and in those who had ever shared paraphernalia for intravenous drug use (p < .001, AOR 6.2 CI 95% 2.5–16.0). Conclusions An important part tested positive for HCV. Treatment could be started in more than half of the chronically infected referred and tested positive for HCV-RNA. Micro-elimination is necessary to achieve the World Health Organization goals by 2030. However, it remains crucial to screen and link a broader group of PWUD to care than to focus solely on those who inject drugs. Trial registration: clinicaltrials.gov NCT04363411, Registered 27 April 2020—Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT04363411?term=NCT04363411&draw=2&rank=1

Reaching Hard-to-Reach People Who Use Drugs: A Community-Based Strategy for the Elimination of Hepatitis C

“…In Belgium, a similar peer outreach screening approach targeting PWUD resulted in major losses throughout the cascade of care with 63 of 425 (14.8%) testing HCV seropositive, 88.9% of whom were referred, and 66.1% of whom were finally linked to care and tested for HCV RNA. Among the 29 (78.4%) with chronic HCV, DAA treatment was initiated in only 17 (58%) with no report of SVR12 [ 31 ].…”

“…The RDS surveys also allow for an accelerated recruitment. For example, in Antwerp, 36 days of outreach screening in 18 locations recruited 425 PWUD over the course of 1 year, whereas we recruited a similar number in fewer than 3 months from 1 site [ 31 ]. Furthermore, the choice of a neutral, temporary site, outside of the usual health services, was likely a motivating factor for those reluctant to attend usual services.…”

Ten years countdown to hepatitis C elimination in Belgium: a mathematical modeling approach

“…For this study, national experts provided the exact figures of treatment between 2015 and 2019. Moreover, in recent years studies have been conducted in both the general population and in high-risk groups (e.g., migrants, prisoners, drug users, people living with HIV), resulting in this study being more accurate [8][9][10].…”

“…There have been continued efforts to collect more data on, e.g., HCV seroprevalence and treatment outcomes, owing to the increased attention to HCV in recent years. In recent years, studies have been conducted in both the general population and high-risk groups (e.g., migrants, prisoners, drug users, people living with HIV) [8][9][10]. These studies add new prevalence data combined with sociodemographic data.…”

Phylogenetic Analysis of Hepatitis C Virus Infections in a Large Belgian Cohort Using Next-Generation Sequencing of Full-Length Genomes

“…While iatrogenic infections remain a significant route of transmission in resource-limited settings, the HCV epidemics of Western countries are now mainly perpetuated in defined subpopulations such as the incarcerated, people who inject drugs (PWID), and men who have sex with men (MSM). HCV and human immunodeficiency virus (HIV) share similar socio-demographic risk factors and transmission routes, and a co-infection can complicate and accelerate the disease progression of HCV [3][4][5]. Treatment as prevention is the most important tool for managing the epidemic outside of harm reduction initiatives such as needle exchange programmes, since modern direct-acting antivirals (DAA) can cure >95% of treated HCV infected patients [6,7], and no prophylactic vaccine is available.…”