Expanding HCV Care: Effectiveness of Accessible Testing and Treatment for People Who Inject Drugs
By implementing rapid point-of-care HCV RNA testing in supervised consumption services, a study achieved high testing acceptance and successful engagement with HCV care among individuals who inject drugs.
People who inject drugs face significant barriers to accessing care for hepatitis C virus (HCV). Despite a high burden of HCV among injection drug users, stigma or discrimination, complicated venous access, and misinformation about HCV status and treatment options can prevent this population from receiving the necessary care.
One study, recently published in The Lancet Regional Health, sought to evaluate the effectiveness of providing rapid, low-barrier point-of-care (POC) HCV RNA testing and facilitating linkage to care for clients of a supervised consumption service (SCS) within a community health center.
The study also assessed the prevalence of HCV RNA at baseline, measuring HCV incidence during follow-up and identifying factors associated with HCV RNA positivity and treatment uptake.
The study took place in the supervised consumption services (SCS) of South Riverdale Community Health Center in Toronto, Canada. The nonprofit organization provides primary health care and health promotion programs to individuals who may or may not use drugs. The SCS can accommodate up to 5 injections/consumptions at a time, with an average of 17 visits per day during the study period.
From August 13, 2018—September 30, 2021, the investigators enrolled participants in a prospective, observational cohort. Individuals with positive HCV RNA tests were offered immediate referral to onsite treatment, while those with negative results were provided the option of repeat testing every 3 months for up to 4 visits.
HCV incidence was calculated as the number of new HCV infections per 100 person-years at risk, among those who were HCV RNA negative at baseline and returned for at least 1 follow-up visit. Any missing data were noted in the findings.
A total of 128 participants were initially enrolled, but 4 were later deemed ineligible and removed from the study. At baseline, 54 of 124 eligible participants (43.5%) tested positive for HCV RNA. The estimated HCV incidence was 35.1 cases per 100 person-years, with a cumulative incidence of 38.3% at 15 months of follow-up. Among the 64 participants who tested positive for HCV RNA at baseline or during follow-up, 67.2% (n = 43) were successfully linked to HCV care, and treatment was initiated for 67.4% (n = 29) of them.
The high prevalence and incidence of HCV RNA among participants indicate that the SCS serves a population at high risk for HCV infection. The acceptance of testing was high, and a substantial proportion of individuals engaged with HCV care and treatment. The availability of POC HCV RNA testing at SCSs demonstrates their crucial role in facilitating access to HCV care.
This study highlights the effectiveness of offering rapid, low-barrier point-of-care (POC) HCV RNA testing and linkage to care for individuals who inject drugs. “By offering POC HCV RNA testing in a place where people who use drugs already go,” the investigators wrote, “our model succeeded in expanding access to HCV RNA testing to a highly marginalized group of individuals at high risk of HCV acquisition.”
The findings emphasize the importance of SCSs as an integral part of the healthcare system, offering vital access to HCV care for high-risk populations.
