Identification and treatment of viral hepatitis C in persons who use drugs: a prospective, multicenter outreach study in Flanders, Belgium

Dana Busschots, Cécile Kremer, Rob Bielen, Özgür Muhammet Koc, Leen Heyens, Eefje Dercon, Rita Verrando, Tessa Windelinckx, Griet Maertens, Stefan Bourgeois, Niel Hens, Catharina Matheï, Geert Robaeys, Dana Busschots, Cécile Kremer, Rob Bielen, Özgür Muhammet Koc, Leen Heyens, Eefje Dercon, Rita Verrando, Tessa Windelinckx, Griet Maertens, Stefan Bourgeois, Niel Hens, Catharina Matheï, Geert Robaeys

Abstract

Background: Targeted screening for hepatitis C viral (HCV) infection is not yet widely executed in Belgium. When performed in people who use drugs (PWUD), it is mainly focused on those receiving opiate agonist therapy (OAT). We wanted to reach out to a population of difficult to reach PWUD not on centralized OAT, using non-invasive screening as a bridge to re-integration in medical care supported by facilitated referral to a specialist.

Methods: This was a prospective, multicenter cohort study in PWUD not enrolled in a centralized OAT program in a community-based facility in Limburg or OAT program in a community-based facility in Antwerp, Belgium, from October 2018 until October 2019. Two study teams recruited participants using an outreach method at 18 different locations. Participants were tested for HCV antibodies (Ab) by finger prick, and risk factors were assessed through a face-to-face questionnaire. Univariate analyses were used to assess the association between HCV Ab and each risk factor separately. A generalized linear mixed model was used to investigate the association between the different risk factors and HCV.

Results: In total, 425 PWUD were reached with a mean age of 41.6 ± 10.8, and 78.8% (335/425) were men. HCV Ab prevalence was 14.8% (63/425). Fifty-six (88.9%) PWUD were referred, of whom 37 (66.1%) were linked to care and tested for HCV RNA. Twenty-nine (78.4%) had a chronic HCV infection. Treatment was initiated in 17 (58.6%) patients. The adjusted odds for HCV Ab were highest in those with unstable housing 6 months before inclusion (p < .001, AOR 8.2 CI 95% 3.2-23.3) and in those who had ever shared paraphernalia for intravenous drug use (p < .001, AOR 6.2 CI 95% 2.5-16.0).

Conclusions: An important part tested positive for HCV. Treatment could be started in more than half of the chronically infected referred and tested positive for HCV-RNA. Micro-elimination is necessary to achieve the World Health Organization goals by 2030. However, it remains crucial to screen and link a broader group of PWUD to care than to focus solely on those who inject drugs.

Trial registration: clinicaltrials.gov NCT04363411, Registered 27 April 2020-Retrospectively registered. https://ichgcp.net/clinical-trials-registry/NCT04363411?term=NCT04363411&draw=2&rank=1.

Keywords: Hepatitis C virus; High-income country; Linkage to care; Outreach; People who use drugs.

Conflict of interest statement

D.B. has received travel grants from AbbVie and Gilead Sciences and research grants from Gilead; R.B. has received travel grants from AbbVie, Gilead Sciences, and MSD and research grants from Gilead and MSD; Ö.K. has received a travel grant and research grants from Gilead and CyTuVax BV; N.H. has received grants from GlaxoSmithKline (GSK), grants from Johnson & Johnson pharmaceuticals and grants from Pfizer; C.M has received travel grants from Gilead, MSD Belgium, and INDIVIOR and has acted as consultant for MSD Belgium; G.R. has received research grants from AbbVie, Janssen Pharmaceuticals, MSD, and has acted as a consultant/advisor for AbbVie, BMS, Gilead Sciences, and MSD. All other co-authors report no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart for people who use drugs recruited by outreach and linked to care in Belgium

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Source: PubMed

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