Network‐based recruitment of people who inject drugs for hepatitis C testing and linkage to care

Abstract

Although oral direct‐acting agent (DAA) therapies have the potential to reduce the burden of hepatitis C virus (HCV) infection, treatment uptake remains low, particularly among people who inject drugs (PWID). This study examined the feasibility of an innovative peer‐based recruitment strategy to engage PWID in HCV testing and treatment. We interviewed an initial set of HCV antibody‐positive PWID as ‘primary indexes’ to gather demographic, drug use, health information and drug network characteristics. Primary indexes were then briefly educated on HCV and its treatment and encouraged to recruit their injection drug ‘network members’ for HCV testing and linkage to care. Eligible network members were enrolled as ‘secondary indexes’ and completed the same index study procedures. In sum, 17 of 36 primary indexes initiated the recruitment of 64 network members who were HCV antibody positive and eligible to become indexes. In multivariable analysis, successful recruitment of at least one network member was positively associated with prior HCV treatment (OR 2.80; CI [1.01, 7.72]), daily or more injection drug use (OR 2.38; CI [1.04, 5.47]), and a higher number of injection drug network members (OR 1.20; CI [1.01, 1.42]). Among the 69 participants with chronic HCV not previously linked to HCV care at enrolment, 91% (n = 63) completed a linkage to HCV care appointment, 45% (n = 31) scheduled an appointment with an HCV provider, and 20% (n = 14) initiated HCV therapy. These findings suggest a potential benefit for peer‐driven, network‐based interventions focused on HCV treatment‐experienced PWID as a mechanism to increase HCV linkage to care.

Hepatitis C treatment uptake among people who inject drugs in the oral direct‐acting antiviral era

“…Increased access to HCV linkage to care and treatment through expansion into non‐traditional settings, such as substance use disorder treatment programmes, mental health clinics, public health clinics, halfway houses and mobile van‐based sites, has potential for effectiveness in this regard. Strategies to support engagement in care such as peer‐based and network approaches may also increase HCV treatment uptake 55 …”

Injecting network structure determines the most efficient strategy to achieve Hepatitis C elimination in people who inject drugs

“…If this structure is the closest to ‘real‐world’ networks then the TasP effects of targeting HCV treatment at individuals with the largest numbers of injecting partnerships may have been underestimated. Such an approach is practically possible by engaging PWID with HCV treatment via peer‐led referral, 33 and the increasing availability of point of care RNA testing will support monitoring for reinfection in high risk PWID 34,35 …”

Against All Odds? Addiction History Associated with Better Viral Hepatitis Care: A Dutch Nationwide Claims Data Study

“…Failure to initiate treatment puts patients at a risk of liver-related complications and maintains a viral reservoir. Several reasons have been put forward to explain low treatment rates in PWID, such as absence of insurance coverage [16], logistic inability to utilize care services outside the patient's community [17], and personal barriers for engaging in testing and treatment [18][19][20]. Treating physicians might also experience barriers for treatment initiation in PWID, as they may deem them incapable of adhering to treatment [19,21,22].…”