Time matters: Point of care screening and streamlined linkage to care dramatically improves hepatitis C treatment uptake in prisoners in England

People who inject drugs (PWID) and other marginalized populations with high hepatitis C virus (HCV) infection rates represent a unique challenge for treatment initiation due to health, administrative and social barriers. We analyzed the HCV cascade of care (CoC) in some vulnerable subpopulations in Madrid, Spain, when using a mobile point of care. to identify gaps and barriers to improve HCV elimination efforts in these populations. Methods: From 2019 to 2021, a mobile unit was used to screen for HCV using a linkage-to-care and two-step point-of-care-based strategy. Viremic participants were grouped into four subgroups: PWID, homeless individuals, people with a mental health disorder (MHD) and people with alcohol use disorder (AUD). Logistic regression and Cox and Aalen’s additive models were used to analyze associated factors and differences between groups. Results: A prospectively recruited cohort of 214 HCV infected individuals (73 PWID, 141 homeless, 57 with a MHD and 91 with AUD) participated in the study. The overall HCV CoC analysis found that: 178 (83.1%) attended a hospital, 164 (76.6%) initiated direct-acting antiviral therapy and 141 (65.8%) completed therapy, of which 99 (95.2%) achieved a sustained virological response (SVR). PWID were significantly less likely to initiate treatment, while individuals with AUD waited longer before starting treatment. Both people with AUD and PWID were significantly less likely to complete HCV treatment. Conclusions: Overall, SVR was achieved in the majority of the participants treated. However, PWID need better linkage to care and treatment, while PWID and AUD need more support for treatment completion.

Download Full-text

Hepatitis C testing and linkage to care among adults on probation in a large US city

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab636 ◽

2021 ◽

Author(s):

Kevin F Kamis ◽

David L Wyles ◽

Matthew S Minturn ◽

Tracy Scott ◽

Dean McEwen ◽

...

Keyword(s):

Hepatitis C ◽

Point Of Care ◽

Linkage To Care ◽

Virologic Response ◽

Patient Navigator ◽

Hcv Rna ◽

Study Cohort ◽

Hcv Treatment ◽

Hiv Test ◽

Hcv Testing

Abstract Background Despite constituting the largest segment of the correctional population, individuals on probation remain largely unstudied with respect to hepatitis C virus (HCV) testing and linkage-to-care. We implemented an HCV testing and patient navigation program at an adult probation department. Methods Adults were tested at a local probation department with a rapid point-of-care HCV antibody (Ab) assay followed by a lab-based HCV RNA assay if anti-HCV positive. All individuals received counseling rooted in harm-reduction principles. Individuals testing positive for HCV Ab were immediately linked to a patient navigator in person or via telephone. The patient navigator assisted patients through cure unless lost to follow-up. Study participation involved an optional survey and optional point-of-care HIV test. Results Of 417 individuals tested, 13% were HCV Ab positive and 65% of those tested for HCV RNA (34/52) had detectable HCV RNA. Of the 14 individuals who linked to an HCV treatment provider, 4 completed treatment as measured by pharmacy fill documentation in the electronic medical record, and 1 obtained sustained virologic response. 193 individuals tested for HIV; none tested positive. Conclusions The study cohort had a higher HCV seroprevalence than the general population (13% vs 2%), but linkage-to-care, completion of HCV treatment, and successful test-of-cure rates were all low. This study indicates that HCV disproportionately impacts adults on probation and prioritizing support for testing and linkage-to-care could improve health in this population. Co-localization of HCV treatment within probation programs would reduce the barrier of attending a new institution and could be highly impactful.

Download Full-text