Model of Care for Microelimination of Hepatitis C Virus Infection among People Who Inject Drugs

Abstract

Background: People who inject drugs (PWID) are the largest group at risk for HCV infection. Despite the direct acting antivirals (DAA) advancements, HCV elimination has been hindered by real-life difficulties in PWID. Aims: This study aimed to assess the impact of a multidisciplinary intervention strategy where HCV screening, treatment and follow-up were performed at the same location on efficacy and safety of DAA-therapy in real-life PWID population. Methods: All HCV-infected PWID referred to five specialized outpatient centers for drug addicts (SerDs) in Northern Italy were prospectively enrolled from May 2015 to December 2019. Hepatologists and SerDs healthcare workers collaborated together in the management of PWID inside the SerDs. Sustained virologic response (SVR), safety of treatment, proportion of patients lost to follow-up and reinfection rate were evaluated. Results: A total of 358 PWID started antiviral treatment. About 50% of patients had advanced fibrosis/cirrhosis, 69% received opioid substitution treatment, and 20.7% self-reported recent injecting use. SVR was achieved in 338 (94.4%) patients. Two patients died during treatment; one prematurely discontinued, resulting in a non-responder; twelve were lost during treatment/follow-up; and five relapsed. No serious adverse events were reported. SVR was lower in recent PWID than in former ones (89.2% vs. 95.8%; p = 0.028). Seven reinfections were detected, equating to an incidence of 1.25/100 person-years. Reinfection was associated with recent drug use (OR 11.07, 95%CI 2.10–58.38; p = 0.005). Conclusion: Our embedded treatment model could be appropriate to increase the linkage to care of HCV-infected PWID. In this setting, DAA regimens are well tolerated and highly effective, achieving a lower rate of reinfection.

Impact of voluntary testing on infectious disease epidemiology: A game theoretic approach

“…[83]-[86], geographical area [87]-[89], sexual behavior (e.g., MSM, sex workers) [90], [91], or high-risk of infection (e.g., drug users) [92] with the goal to achieve local elimination, so-called micro-elimination [75],…”

Out-of-Hospital Treatment of Hepatitis C Increases Retention in Care among People Who Inject Drugs and Homeless Persons: An Observational Study

“…Attempts to associate harm reduction interventions simultaneously with the administration of safe and short therapeutic regimens may favor a lowered transmission of the virus and a reduction of liver damage in these populations [ 9 , 10 ]. For these reasons, alternative models of care in out-of-hospital setting are spreading in Europe and Italy, with encouraging results [ 24 , 25 , 26 ]. Our study showed how an out-of-hospital care model might guarantee a greater percentage of patients starting DAAs with an overall better retention in care for difficult-to-reach groups with HCV infection.…”

“…Moreover, the presence of peer educators may have contributed to improve the linkage to care in the out-of-hospital setting. Starting treatment quickly and in a more individualized way improved the retention in care of PWID [ 17 , 20 , 24 , 26 ]. In agreement with our findings, recent research conducted in Vienna on DAAs administration as DOT (given at OST facilities) in PWID showed excellent SVR12 rates (99%) in this difficult-to-treat population, similar to patients with expected high treatment compliance in a standard setting [ 27 ].…”

“…In Italy, out-of-hospital care models are emerging with the presence of dedicated doctors, nurses, and peer-educators with experience in drug addiction [ 24 , 25 , 26 ]. In Italy, the “Stop HCV” project was conceived and conducted in the city of Bologna with the help of the “Open Group-Unità di Strada”, a non-profit organization of harm reduction.…”

Impact of voluntary testing on infectious disease epidemiology: A game theoretic approach

“…Eventually, 89% of them had their HIV status ever ascertained [87], demonstrating that, in this context, offering testing at home considerably decreased the cost of testing. Testand-treat strategies have also been employed in smaller trials, for specific demographic subgroups, defined by social status (e.g., incarcerated individuals) [88-91], geographical area [92][93][94], sexual behavior (e.g., MSM, sex workers) [95,96], or risk of infection (e.g., drug users) [97] with the goal to achieve local elimination, so-called micro-elimination [98,99]. Some of these trials achieved very high participation and testing rates from the eligible populations, much larger than those reported in the studies of the general population.…”