CHIME - A tailored HCV microelimination project in Viennese people who inject drugs at drug centralized substitution centers.

Background

Hepatitis C remains highly prevalent among people who inject drugs (PWIDs). We propose an integrated approach for screening/diagnostic testing and treatment in 6,665 Viennese PWIDs registered to access opioid agonist therapy (OAT).

Methods

OAT prescriptions were required monthly at one of nine approved authorities, making them ideal platforms for hepatitis C virus (HCV) screening. All PWIDs attending these authorities between January 2019 and March 2020 were offered on-site HCV screening, and consecutive HCV RNA PCR in case of positive HCV serology. In HCV viremic PWIDs, offsite referral to HCV care and treatment according to directly observed therapy (DOT) alongside OAT were performed.

Results

4,327/6,665 (64.9%) individuals were contacted before the COVID-19-related project discontinuation. There were 1,538/4,327 (35.5%) individuals who had participated in the study. HCV serology was available in 1,510/1,538 (98.2%): 795/1,519 (52.6%) had a positive serology, among whom 632 (79.5%) were followed-up with a PCR test. In 8/1,538 (0.5%) additional study participants HCV RNA PCR was assessed without prior serological screening. 239/640 (37.3%) individuals were HCV viremic with 51 (21.3%) having started on direct-acting antivirals (DAAs). 48/51 (94.1%) had completed treatment, among whom 42 (87.5% according to ITT) had achieved sustained virologic response at 12 weeks after completing treatment (SVR12) and 6 (12.5%) had been lost to follow-up after completion of therapy (SVR12 according to mITT: 42/42, 100%). No treatment failures had occurred.

Conclusion

Providing integrated point-of-care HCV screening/diagnostic testing at central OAT approved centers, followed by DOT with DAAs, represents an effective HCV microelimination strategy. While some PWIDs were lost in the cascade to cure and the absolute number of SVR was limited by the COVID-19 pandemic, our approach will allow linkage to care in a large proportion of Viennese PWIDs.

Informations de copyright

© 2023 The Authors.

Déclaration de conflit d'intérêts

Schwarz C. ([e-mail]): received travel support from Gilead, Abbvie, and Gebro; speaking honoraria from Abbvie and Gilead; and served as a consultant for Gilead. Schubert R. ([e-mail]): was employed by Suchthilfe Wien gGmbH and received travel support from Gilead. Schwarz M. ([e-mail]): received speaking honoraria from BMS and travel support from BMS, MSD, Abbvie and Gilead. Schütz A. ([e-mail]): is employed by Suchthilfe Wien gGmbH and has no conflicts of interest. Jenke A. ([e-mail]): has no conflicts of interest. Bauer D. ([e-mail]): received travel support from Gilead and Siemens, served as a speaker/advisor for AbbVie and Siemens, and received grant support from Gilead, Philips, and Siemens. Steinwender B. ([e-mail]): was employed by Suchthilfe Wien gGmbH and has no conflicts of interest. Gutic E. ([e-mail]): received travel support from Gilead and Abbvie. Reiberger T. ([e-mail]): received grant support from Abbvie, Boehringer-Ingelheim, Gilead, MSD, Philips Healthcare, Gore; speaking honoraria from Abbvie, Gilead, Gore, Intercept, Roche, MSD; consulting/advisory board fee from Abbvie, Bayer, Boehringer-Ingelheim, Gilead, Intercept, MSD, Siemens; and travel support from Boehringer-Ingelheim, Gilead and Roche. Haltmayer H. ([e-mail]): is employed by Suchthilfe Wien gGmbH and has no conflicts of interest. Gschwantler M. ([e-mail]): received grant support from Abbvie, Gilead and MSD; speaking honoraria from Abbvie, Gilead, Intercept, Janssen, BMS, Roche, Norgine, AstraZeneca, Falk, Shionogi, and MSD; consulting/advisory board fees from Abbvie, Gilead, Intercept, Janssen, BMS, Roche, Alnylam, Norgine, AstraZeneca, Falk, Shionogi and MSD; and travel support from Abbvie and Gilead.