Simplified and Integrated Hepatitis C Virus Testing and Treatment Algorithm for Unhoused People Who Inject Drugs

Hepatitis C virus (HCV) infection disproportionately affects people who inject drugs (PWID), particularly people experiencing homelessness, who face significant barriers to testing and treatment. Simplified testing and treatment algorithms, including the use of mobile medical units (MMUs), may improve access to care for this population. This study evaluated the effectiveness of a simplified HCV testing and treatment algorithm with integrated care delivered via MMU to unhoused PWID in an urban United States setting.

This pragmatic, randomized controlled trial compared a simplified MMU care model with usual care among 201 PWID who tested positive for HCV antibody. Patients were randomized into simplified MMU or usual care. The primary outcome was treatment initiation within 6 months. Secondary outcomes included treatment completion, sustained virologic response at 12 weeks (SVR12), and initiation of medication-assisted treatment for opioid use disorder.

Of 98 patients with confirmed HCV RNA, 33% in the MMU group initiated treatment compared to 24% in the usual care group (P = .4). Treatment completion and SVR12 rates were higher in the usual care group (16% vs 10% and 12% vs 4%, respectively), but differences were not statistically significant. MMUs facilitated faster treatment initiation but encountered challenges with patient retention and follow-up.

While the MMU model demonstrated potential for improving rapid access to HCV treatment, overall treatment initiation, retention, and cure rates remained low. A critical need remains to develop approaches that more closely approximate a test-and-treat model to increase treatment initiation and completion and achieve elimination in unhoused PWID.

NCT04741750.