Accessible Hepatitis C Care for People Who Inject Drugs: A Randomized Clinical Trial

Area of Science:

• Hepatology
• Public Health
• Infectious Diseases

Background:

• Hepatitis C elimination requires effective engagement of people who inject drugs (PWID).
• Traditional treatment models face challenges in reaching and retaining PWID.
• Novel approaches are needed to improve hepatitis C virus (HCV) treatment outcomes in this population.

Purpose of the Study:

• To compare a low-threshold, nonstigmatizing HCV treatment program co-located at a syringe service program (accessible care) with facilitated referral (usual care).
• To evaluate the effectiveness of accessible care in achieving sustained virologic response (SVR) among PWID with HCV.

Main Methods:

• A single-site randomized clinical trial was conducted at a syringe service program in New York.
• 167 participants who injected drugs in the prior 90 days and were HCV RNA-positive were randomized 1:1 to accessible care or usual care.
• The primary endpoint was SVR within 12 months of enrollment.

Main Results:

• The accessible care arm achieved significantly higher SVR rates (67.1%) compared to the usual care arm (22.9%) (P < .001).
• Loss to follow-up was similar between the two arms.
• The accessible care model facilitated greater engagement across the HCV care cascade, particularly in referral and clinical visit attendance.

Conclusions:

• A low-threshold, co-located, and flexible HCV care model significantly improves treatment cure rates among people who inject drugs.
• This accessible care approach is paramount for achieving hepatitis C elimination.
• Expanding tailored treatment programs for PWID is essential for public health.