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Integrated HCV care in HIV centers reaches more PWID than usual care

Results from a real-world study of implementing hepatitis C testing into integrated care centers that deliver HIV services to people who inject drugs demonstrated superior infection awareness, testing and treatment compared with usual care.

“Calls have been made for integrating HCV testing with existing services including harm reduction and HIV prevention and treatment particularly for drug using populations, but there are few empirical trials to date,” Sunil Suhas Solomon, PhD, from Johns Hopkins University School of Medicine in Baltimore, Maryland, and colleagues wrote. “Over a short duration, we observed significant impact on community-level HCV testing and awareness of HCV status among PWID.”

Solomon and colleagues recruited 11,993 PWID at baseline in 2013 from six integrated care centers (ICCs) and six centers providing usual care, with 11,721 available for follow-up evaluation between 2016 and 2017. The ICCs were within either a government facility or nongovernment organization and provided services for PWID in a single PWID-friendly venue.

In the community-level analysis, PWID who received care at ICCs were nearly four times more likely to have ever received HCV testing (adjusted prevalence ratio = 3.69; 95% CI, 1.34-10.2) and more likely to have been tested in the 12 months prior to baseline (aPR = 5.55; 95% CI, 1.48-20.8) compared with those who received usual care.

Adjusting for baseline levels of HCV status awareness, PWID at an ICC were seven times more likely to be aware if they were HCV-positive (aPR = 7.11; 95% CI, 1.14-44.3) compared with the usual care group. PWID in the ICC group were also more likely to be linked to care, initiate treatment, and achieve sustained virologic response.

“The simplification of HCV treatment and availability of generic [direct-acting antivirals] in over 100 countries further supports task-shifting from tertiary specialty centers to community-based centers such as the ICCs described in this trial to potentially further improve HCV testing and downstream outcomes of SVR and consequently, reduce HCV incidence,” the researchers wrote.

Multivariate analysis adjusted for age showed that PWID recruited to the ICC group who reported recent testing were significantly more likely to have visited the ICC (aPR = 1.74; 95% CI, 1.44-2.10), accessed opioid agonist therapy in the prior 6 months (aPR = 1.72; 95% CI, 1.22-2.43) and be recently tested for HIV (aPR = 5.23; 95% CI, 3.1-8.9) or aware of their HIV positive status (aPR = 4.35; 95% CI, 2.51-7.51).

“While additional strategies might be required to improve population awareness levels, integration of HCV testing with HIV programs for PWID particularly given the high burden of HIV/HCV coinfection represents a critical first step,” Solomon and colleagues concluded. “To achieve elimination targets, programs will also need to consider delivering HCV treatment from such venues.” – by Talitha Bennett

Disclosures: Solomon reports speaker fees from Gilead Sciences. Please see the full study for all other authors’ relevant financial disclosures.