HCV microelimination in harm reduction centres has benefits beyond HCV cure but is hampered by high reinfection rates

Significant scale-up of treatment among people who inject drugs (PWID) is crucial to achieve WHO HCV elimination targets. We explored the impact of on-site HCV diagnosis and treatment on PWID in an externalised hepatology clinic at the biggest harm reduction centre (HRC) in Barcelona attending to a...

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Authors: Lens García, Sabela, Miralpeix, Anna, Gálvez, Mont, Martró, Elisa, González, Noemí, Rodríguez Tajes, Sergio, Mariño Méndez, Zoe, Saludes, Verónica, Reyes Urueña, Juliana, Majó, Xavier, Colom, Joan, Forns, Xavier
Format: article
Status:Published version
Publication Date:2022
Country:España
Institution:Universidad de Barcelona
Repository:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/209166
Online Access:https://hdl.handle.net/2445/209166
Access Level:Open access
Keyword:Hepatitis C
Drogoaddictes
Drug addicts
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spelling HCV microelimination in harm reduction centres has benefits beyond HCV cure but is hampered by high reinfection ratesLens García, SabelaMiralpeix, AnnaGálvez, MontMartró, ElisaGonzález, NoemíRodríguez Tajes, SergioMariño Méndez, ZoeSaludes, VerónicaReyes Urueña, JulianaMajó, XavierColom, JoanForns, XavierHepatitis CDrogoaddictesHepatitis CDrug addictsSignificant scale-up of treatment among people who inject drugs (PWID) is crucial to achieve WHO HCV elimination targets. We explored the impact of on-site HCV diagnosis and treatment on PWID in an externalised hepatology clinic at the biggest harm reduction centre (HRC) in Barcelona attending to a marginalised PWID population with ongoing high-risk practices.On-site HCV point-of-care testing was performed for diagnosis and treatment delivery. HCV-RNA was assessed at SVR12 (sustained virologic response at 12 weeks) and every 6 months. The programme included behavioural questionnaires at baseline and after treatment.Between 2018 and 2020, 919 individuals were prospectively enrolled. Of these, only 46% accepted HCV screening. HCV-RNA+ prevalence was 55.7% (n = 234). Of the 168 (72%) individuals starting treatment, 48% were foreigners, 32% homeless, 73% unemployed, and 62% had a history of incarceration. At enrolment, 70% injected drugs daily and 30% reported sharing needles or paraphernalia. Intention-to-treat SVR12 was 60%; only 4% were virological failures, the remaining were either early reinfections (20%) or losses to follow-up (16%). The overall reinfection rate during follow-up was 31/100 persons/year. HIV coinfection and daily injection were associated with a higher risk of reinfection. Nonetheless, beyond viral clearance, antiviral therapy was associated with a significant reduction in injection frequency, risk practices, and homelessness.HCV treatment can be successfully delivered to active PWID with high-risk practices and has a significant benefit beyond HCV elimination. However, approaching this difficult spectrum of the PWID population implies significant barriers such as low rate of screening acceptance and high dropout and reinfection rates.People who inject drugs attending harm reduction centres represent the most difficult population to treat for hepatitis C. We show that hepatitis C treatment has a significant benefit beyond viral cure, including improving quality of life, and decreasing injection frequency and risk practices. However, intrinsic barriers and the high reinfection rates hamper the achievement of viral microelimination in this setting.© 2022 The Author(s).Elsevier BV2022info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://hdl.handle.net/2445/209166Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer)reponame:Dipòsit Digital de la UBinstname:Universidad de BarcelonaInglésReproducció del document publicat a: https://doi.org/10.1016/j.jhepr.2022.100580JHEP Reports, 2022, vol. 4, num. 12https://doi.org/10.1016/j.jhepr.2022.100580cc by-nc-nd (c) Lens, Sabela et al., 2022http://creativecommons.org/licenses/by-nc-nd/3.0/es/info:eu-repo/semantics/openAccessoai:diposit.ub.edu:2445/2091662026-05-27T06:46:51Z
dc.title.none.fl_str_mv HCV microelimination in harm reduction centres has benefits beyond HCV cure but is hampered by high reinfection rates
title HCV microelimination in harm reduction centres has benefits beyond HCV cure but is hampered by high reinfection rates
spellingShingle HCV microelimination in harm reduction centres has benefits beyond HCV cure but is hampered by high reinfection rates
Lens García, Sabela
Hepatitis C
Drogoaddictes
Hepatitis C
Drug addicts
title_short HCV microelimination in harm reduction centres has benefits beyond HCV cure but is hampered by high reinfection rates
title_full HCV microelimination in harm reduction centres has benefits beyond HCV cure but is hampered by high reinfection rates
title_fullStr HCV microelimination in harm reduction centres has benefits beyond HCV cure but is hampered by high reinfection rates
title_full_unstemmed HCV microelimination in harm reduction centres has benefits beyond HCV cure but is hampered by high reinfection rates
title_sort HCV microelimination in harm reduction centres has benefits beyond HCV cure but is hampered by high reinfection rates
dc.creator.none.fl_str_mv Lens García, Sabela
Miralpeix, Anna
Gálvez, Mont
Martró, Elisa
González, Noemí
Rodríguez Tajes, Sergio
Mariño Méndez, Zoe
Saludes, Verónica
Reyes Urueña, Juliana
Majó, Xavier
Colom, Joan
Forns, Xavier
author Lens García, Sabela
author_facet Lens García, Sabela
Miralpeix, Anna
Gálvez, Mont
Martró, Elisa
González, Noemí
Rodríguez Tajes, Sergio
Mariño Méndez, Zoe
Saludes, Verónica
Reyes Urueña, Juliana
Majó, Xavier
Colom, Joan
Forns, Xavier
author_role author
author2 Miralpeix, Anna
Gálvez, Mont
Martró, Elisa
González, Noemí
Rodríguez Tajes, Sergio
Mariño Méndez, Zoe
Saludes, Verónica
Reyes Urueña, Juliana
Majó, Xavier
Colom, Joan
Forns, Xavier
author2_role author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Hepatitis C
Drogoaddictes
Hepatitis C
Drug addicts
topic Hepatitis C
Drogoaddictes
Hepatitis C
Drug addicts
description Significant scale-up of treatment among people who inject drugs (PWID) is crucial to achieve WHO HCV elimination targets. We explored the impact of on-site HCV diagnosis and treatment on PWID in an externalised hepatology clinic at the biggest harm reduction centre (HRC) in Barcelona attending to a marginalised PWID population with ongoing high-risk practices.On-site HCV point-of-care testing was performed for diagnosis and treatment delivery. HCV-RNA was assessed at SVR12 (sustained virologic response at 12 weeks) and every 6 months. The programme included behavioural questionnaires at baseline and after treatment.Between 2018 and 2020, 919 individuals were prospectively enrolled. Of these, only 46% accepted HCV screening. HCV-RNA+ prevalence was 55.7% (n = 234). Of the 168 (72%) individuals starting treatment, 48% were foreigners, 32% homeless, 73% unemployed, and 62% had a history of incarceration. At enrolment, 70% injected drugs daily and 30% reported sharing needles or paraphernalia. Intention-to-treat SVR12 was 60%; only 4% were virological failures, the remaining were either early reinfections (20%) or losses to follow-up (16%). The overall reinfection rate during follow-up was 31/100 persons/year. HIV coinfection and daily injection were associated with a higher risk of reinfection. Nonetheless, beyond viral clearance, antiviral therapy was associated with a significant reduction in injection frequency, risk practices, and homelessness.HCV treatment can be successfully delivered to active PWID with high-risk practices and has a significant benefit beyond HCV elimination. However, approaching this difficult spectrum of the PWID population implies significant barriers such as low rate of screening acceptance and high dropout and reinfection rates.People who inject drugs attending harm reduction centres represent the most difficult population to treat for hepatitis C. We show that hepatitis C treatment has a significant benefit beyond viral cure, including improving quality of life, and decreasing injection frequency and risk practices. However, intrinsic barriers and the high reinfection rates hamper the achievement of viral microelimination in this setting.© 2022 The Author(s).
publishDate 2022
dc.date.none.fl_str_mv 2022
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/209166
url https://hdl.handle.net/2445/209166
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.1016/j.jhepr.2022.100580
JHEP Reports, 2022, vol. 4, num. 12
https://doi.org/10.1016/j.jhepr.2022.100580
dc.rights.none.fl_str_mv cc by-nc-nd (c) Lens, Sabela et al., 2022
http://creativecommons.org/licenses/by-nc-nd/3.0/es/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc by-nc-nd (c) Lens, Sabela et al., 2022
http://creativecommons.org/licenses/by-nc-nd/3.0/es/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Elsevier BV
publisher.none.fl_str_mv Elsevier BV
dc.source.none.fl_str_mv Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer)
reponame:Dipòsit Digital de la UB
instname:Universidad de Barcelona
instname_str Universidad de Barcelona
reponame_str Dipòsit Digital de la UB
collection Dipòsit Digital de la UB
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,300719

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