Integrated supervised consumption services and hepatitis C testing and treatment among people who inject drugs in Toronto, Canada: A cross‐sectional analysis

Abstract

Despite the availability of publicly funded hepatitis C (HCV) treatment in Canada, treatment gaps persist, particularly among people who inject drugs. We estimate correlates of HCV care cascade engagement (testing, diagnosis, and treatment) among people who inject drugs in Toronto, Canada and examine the effect of accessing differing supervised consumption service (SCS) models on self-reported HCV testing and treatment. This is a cross-sectional baseline analysis of 701 people who inject drugs surveyed in the Toronto, Ontario integrated Supervised Injection Services (OiSIS-Toronto) study between November 2018 and March 2020. We examine correlates of self-reported HCV care cascade outcomes including SCS model, demographic, socio-structural, drug use, and harm reduction characteristics. Overall, 647 participants (92%) reported ever receiving HCV testing, of whom 336 (52%) had been diagnosed with HCV. Among participants who reported ever being diagnosed with HCV, 281 (84%) reported chronic HCV, of whom 130 (46%) reported HCV treatment uptake and 151 (54%) remained untreated. Compared to those with no SCS use, participants who had ever injected at an integrated SCS model with co-located HCV care had greater prevalence of both ever receiving HCV testing (adjusted prevalence ratio[aPR]: 1.12, 95% confidence interval [CI]: 1.02-1.24) and ever receiving HCV treatment (aPR: 1.67, 95% CI: 1.04-2.69). Over half of participants diagnosed with chronic HCV reported remaining untreated. Our findings suggest that integrated SCS models | 161 GREENWALD et al.

Rapid hepatitis C virus point-of-care RNA testing and treatment at an integrated supervised consumption service in Toronto, Canada: a prospective, observational cohort study

“…The co-location of HCV care in spaces where people who inject drugs feel safe and can access low-threshold supports, such has harm reduction programs or primary care, has been identified as a facilitator to HCV treatment elsewhere. 27 , 28 , 29 , 30 Trust in the team offering testing or treatment was a commonly cited motivation for engagement in care in our study. The study nurse/health centre's HCV nurse was a regular presence in the SCS before and during the study period thereby offering a constant ‘open door’ for counselling and questions.…”

Insights from Drug Checking Programs: Practicing Bootstrap Public Health Whilst Tailoring to Local Drug User Needs

“…Studies exploring the benefits of integrating and co-locating services, such as healthcare provision and supervised consumption across harm reduction and outreach services, broadly may provide useful comparisons for drug checking integration [57][58][59][60][61]. The integration and co-location of services to manage the HIV and HCV epidemics among PWUDs have demonstrable benefits [59] and are robust enough to argue for a similar scaling up in the provision of integrated harm reduction and drug checking.…”