Fingerstick testing increased HCV screening in people who use drugs

Onsite screening with a fingerstick assay at addiction treatment centers increased diagnosis and treatment of hepatitis C among people who use drugs, researchers reported.

“In Italy, we estimate the prevalence of HCV infection in the general population is about one in every 100 people, and we have estimated that 60% to 80% of the population is positive for HCV antibodies,” Lorenzo Somaini, MD, PhD, from the Addiction Treatment Center at the Local Health Unit in Biella, Italy, said during a presentation at The Liver Meeting Digital Experience. “We also have approximately 146,000 people with a history of opioid use disorder or injecting drugs and may require HCV treatment, and overall, we have 300,000 people suffering with opioid use disorder or are currently injecting drugs, so we have a very high prevalence in our population.”

Engaging this patient population in HCV screening and subsequently initiating and completing treatment, however, has proven difficult, Somaini noted.

“Starting from this point of view, we made a prospective pilot project where we evaluated the feasibility and acceptability of HCV viral load fingerstick assay use to improve HCV screening and treatment among Italian people who use drugs at our addiction treatment centers,” Somaini said, acknowledging that the study population was not limited to people who inject drugs.

Between October 2020 and April 2021, Somaini and colleagues invited 909 consecutive people who use drugs seen at five different addiction treatment centers in four different regions of Italy to participate in HCV screening using a fingerstick capillary whole-blood RNA test. The results were delivered directly to the patient after 60 minutes.

Of the 909 invited, 872 patients, or 96%, opted to participate in HCV screening. The mean age was 42.6 years, 78% were male and the mean duration of opioid agonist therapy was 10.3 years. Additionally, 64% had a history of injection drug use and 69% had a history of tattooing. Notably, 39% of patients had never been screened for HCV before, according to Somaini.

Of those included in the study, 78% were heroin-dependent, of whom the majority were on opioid agonist therapy, according to Somaini.

Of the 872 patients enrolled in the study, 20% were HCV RNA-positive, with genotypes 1 and 3 being the most common. Of those who were HCV RNA-positive, 88% were linked to care. Sixty percent of those patients subsequently completed treatment, all of whom achieved sustained virologic response.

“This is one of the largest HCV RNA screening and linkage to care projects performed in people who use drugs attending our treatment centers. This project evidenced the feasibility and acceptability of onsite testing using HCV RNA viral load fingerstick assays, with 96% of the people accepting to undergo this type of screening,” Somaini said. “This easy-to-use approach favors engagement with people who use drugs and increases HCV treatment and elimination, as evidenced by the high rate of treatment completed.”