Rapid HCV treatment model increases cure rates in young people who inject drugs
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The HCV-Seek Test and Rapid Treatment model achieved significantly higher cure rates compared with usual care among young people who inject drugs, according to data presented at IDWeek.
“Young people who inject drugs (PWID) have higher HCV incidence and lower treatment initiation rates compared to their older peers,” Benjamin Eckhardt, MD, MS, an assistant professor at NYU School of Medicine and Bellevue Hospital, said during a prerecorded presentation. “As a result, novel, simplified care models need to be developed to better engage, treat and cure this patient population.”
Eckhardt and colleagues tested the HCV-Seek Test and Rapid Treatment model in a randomized pilot clinical trial. The study included 39 individuals aged 18 to 29 years who were HCV-antibody positive, treatment naive and had injected drugs at least once in the past 30 days. Those who were randomly assigned to the rapid treatment group received same-day medical evaluation as well as confirmatory and baseline lab testing and a 7-day starter pack of Epclusa (sofosbuvir/velpatasvir; Gilead Sciences). Participants in the usual care group received same-day confirmatory testing, and those who tested positive were referred to local health care providers. The researchers evaluated RNA-positive participants for sustained virologic response (SVR) within 12 months of enrollment.
Among the study cohort, 19 participants were randomly assigned to the rapid treatment group and 20 to the usual care group. Overall, 14 participants in the rapid treatment group and 11 in the usual care group were confirmed to be HCV RNA positive.
The median time to treatment initiation in the rapid treatment group was 5 days from enrollment and 1 day from HCV confirmation, according to the researchers. Two participants in this group did not start therapy within 7 days of enrollment — one was incarcerated at the time of testing and the other decided not to receive treatment.
Among the individuals who were HCV RNA positive, the researchers reported that 64.3% in the rapid treatment group and 9.1% in the usual care group had a confirmed SVR. Of the participants in the rapid treatment group who did not achieve an SVR, two had continued viremia and two did not have SVR testing.
“By simplifying and consolidating the initial visit and providing a starter pack, treatment initiation occurred within 7 days in 12 out of the 14 rapid treatment participants, and often on the same day as HCV RNA confirmation,” Eckhardt said. “Meeting young PWID where they’re at and initiating treatment in the moment without the need for repeat visits ... appears to be a promising strategy for treating this hard to reach patient population.”
Perspective
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Joshua Barocas, MD
The study by Eckhardt and colleagues, which assessed rapid “in the field” HCV treatment to usual care — referral to a local provider for treatment — is incredibly important in our work toward ending the HCV epidemic, which is largely occurring now among young PWID. First, the study demonstrated that despite the many structural factors that exist for this population, there is absolutely no reason to systematically exclude them from HCV treatment. A common bias and misconception is that people who use drugs are not interested in improving their health. For those of us who work with this population, we know that is demonstrably false. This study supports this. Second, the study is important because it demonstrated that if we actually meet people where they are instead of expecting them to come to brick-and-mortar buildings, they do better. No one likes coming to a doctor’s office — and many people can’t actually get there even if they wanted to because of structural barriers. We remove those structural barriers and people, not surprisingly, do well. Ultimately, this study is important because it adds to the growing narrative that if we are to end the HCV epidemic in the U.S. (or the HIV epidemic for that matter), then we are going to have to leave our air-conditioned office buildings and bring testing and treatment to where people are.
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Eckhardt B, et al. Abstract 911. Presented at: IDWeek; Sept. 29-Oct. 3, 2021 (virtual meeting).
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