Diagnosis and treatment of hepatitis C virus infection: a tool for engagement with people who inject drugs in Vancouver’s Downtown Eastside

Abstract

Background Vancouver’s Downtown Eastside (DTES) faces the interrelated challenges of poverty, homelessness, mental health, addiction, and medical issues such as hepatitis C virus (HCV). This study evaluates a new model of engagement with people who inject drugs (PWID) in the DTES. Methods Our centre has developed the community pop-up clinic (CPC) to engage vulnerable populations such as PWID. Rapid HCV testing is offered using the OraQuick saliva assay. If a test is positive, immediate medical consultation and an incentivized clinic appointment are offered. At this appointment, an HCV treatment plan is developed, along with a plan for engagement in multidisciplinary care. Results In 12 months, 1,283 OraQuick tests were performed at 44 CPCs; 21% of individuals were found to be positive for HCV (68% of whom were PWID). Of individuals positive for HCV antibodies who consulted with the on-site doctor, 50% engaged in care in our clinic—61% of whom have initiated interferon-free directly acting antiviral (DAA) HCV therapy with 100% cured of HCV (per protocol). Individuals who did not engage in care were significantly more likely to be homeless (P < .0001). Conclusion CPCs paired with a multidisciplinary model of care address the needs of vulnerable populations such as PWID, particularly in the management of HCV with interferon-free DAA therapies.

Hepatitis C virus testing, liver disease assessment and direct‐acting antiviral treatment uptake and outcomes in a service for people who are homeless in Sydney, Australia: The LiveRLife homelessness study

“…HCV treatment uptake and documented cure was suboptimal in the current study and lower than DAA therapy uptake of 61% among a population of PWID in Vancouver, Canada . Notably, in this study by Alimohammadi et al, a significant proportion of those not initiating treatment were homeless .…”

“…HCV treatment uptake and documented cure was suboptimal in the current study and lower than DAA therapy uptake of 61% among a population of PWID in Vancouver, Canada . Notably, in this study by Alimohammadi et al, a significant proportion of those not initiating treatment were homeless . Although treatment uptake in the current study was higher than that (32%) among a sample of PWID in Australia in a study by Butler et al, unstable housing was found to be significantly associated with no treatment uptake .…”

“…Data on linkage to care and treatment outcomes among people who are homeless in the interferon‐free DAA era are beginning to emerge. Our findings are consistent with previous studies showing that people who are homeless are less likely to be linked to HCV care and more likely to be lost to follow‐up . However, high HCV treatment willingness among people who are homeless has been documented .…”

Enablers and barriers for the provision of community‐based HCV treatment: A case study of a real‐world practice

“…The Cure‐it programme's progress was also affected by many factors related to patients such as poverty, unstable housing, active drug use and legal issues. In several previous studies, these factors were reported as barriers to receiving HCV treatment in both interferon‐based and DAA treatment . There are out of pocket costs for PCP’s consultation, filling the script and costs related to transportation, which some patients may not be able or wish to pay .…”

“…Patients’ active drug use and cycling through the criminal justice system were experienced as a barrier that places HCV treatment low in the patients’ list of priorities. Other studies noted that some patients who were using drugs were less likely to initiate and adhere to HCV treatment . Although a recent systematic review showed that PWIDs were able to successfully engage with DAA treatment, it was acknowledged that the included studies in the review had different definitions for recent drug use and many studies provided various adherence supports to improve patients’ engagement with the treatment .…”