The impact of point‐of‐care hepatitis C testing in needle and syringe exchange programs on linkage to care and treatment uptake among people who inject drugs: An Australian pilot study

Abstract

Point-of-care (POC) diagnostics overcome barriers to conventional hepatitis C (HCV) testing in people who inject drugs. This study assessed impact on hepatitis C treatment uptake of POC HCV testing in needle and syringe exchange programs (NSPs). Rapid EC was a single-arm interventional pilot study of HCV POC testing conducted in three inner-city community clinics with NSPs. Twelve months after the POC testing, a retrospective medical record and Pharmaceutical Benefits Scheme audit was performed to determine the number of HCV RNA-positive participants who were prescribed HCV treatment. 70 HCV RNA-positive Rapid EC study participants were included. 44 (63%) were prescribed DAAs; 26 (59%) completed treatment and 15 (34%) had SVR testing, all of whom were cured. Age ≥ 40 years (aOR 3.45, 95% CI 1.10-11.05, p = .03) and secondary school education (aOR 5.8, 95% CI 1.54-21.80, p = .009) had higher likelihood of being prescribed DAAs, whereas homelessness was inversely associated with prescription of DAAs (aOR 0.30, 95% CI 0.09-1.04, p = .057). Median time to receive a DAA script from date of diagnosis was seven days (IQR 0 to 14 days), and time to filling the DAA prescription was 2 days (IQR 0-12 days). In conclusion, provision of

Integration of Hepatitis C and Addiction Treatment in People Who Inject Drugs: The San Patrignano HCV-Free and Drug-Free Experience

“…It is a shared opinion that the treatment of HCV infection should be combined with the treatment of SUD and that one of the most effective strategies is to design micro-elimination interventions. These interventions differ depending on the varying contexts in which they operate but are united with the goal of bringing health care “on the spot” by concentrating all the phases that lead to improved access to care (“cascade of care”) in a single area (“point of care”), rendering it easier to meet patients [ 31 , 32 ]. This avoids the need for patients to access other healthcare facilities, which may sometimes be a place of stigma, deprivation of privacy, or bureaucratic delays.…”

CHIME - A tailored HCV microelimination project in Viennese people who inject drugs at drug centralized substitution centers

“…syringe exchange services) to increase screening and treatment receipt as well as to comply with economic requirements. 32 , 33 , 34 , 35 , 36 , 37 , 38 As demonstrated by the highly successful collaboration in this project, pharmacies represent institutions with great potential to contribute to HCV elimination, not only by supporting treatment adherence but also by expanding the capacity for decentralized screening/diagnostic testing, e.g. by offering point-of-care testing on-site.…”

Pathway to global elimination of hepatitis B: HBV cure is just the first step

“…Appropriate integration of hepatitis B care within child and adolescent health services should be prioritized. However, when HBV cure becomes available, HBV management should pivot into both acute and chronic disease management services to rapidly upscale access to cure, as has been done with hepatitis C cure delivered through needle-syringe programs, 76 for example. HBV testing should be performed in accordance with WHO “5 Cs” guiding principles for testing that enshrines human rights and should be offered within models of care that benefits the health and well-being of people with HBV through linkage to high-quality, evidence-based care, and treatment 75,77,78 …”

“…Simplification of current HBV guidelines to a screen-and-treat approach would reduce the high costs of specialist management and diagnostics, 88 offsetting the higher initial costs of HBV cure. This would facilitate POC test-led, community models of HBV screening, and treatment that have proved highly cost-effective for increasing access to hepatitis C cure when delivered across a diverse range of settings, particularly among marginalized populations 76 . It is likely that the impact of HBV cure when given early in the course of infection will significantly reduce HCC risk; therefore, ongoing HCC surveillance costs might be mitigated if the annual risk of HCC postcure falls below the cost-effectiveness threshold to support ongoing HCC surveillance.…”