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

Christian B Ramers1,2, Natalie Vawter2, Adam Northrup2

  • 1Global Medical Affairs, Gilead Sciences, Foster City, California, USA.

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|June 6, 2025
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Summary

Mobile medical units (MMUs) showed potential for faster Hepatitis C virus (HCV) treatment initiation in people who inject drugs (PWID) experiencing homelessness, but overall cure rates remained low.

Keywords:
hepatitis C treatmentmobile medical clinicpeople experiencing homelessnesspeople who inject drugsquality improvement

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Area of Science:

  • Hepatology
  • Public Health
  • Infectious Diseases

Background:

  • Hepatitis C virus (HCV) disproportionately affects people who inject drugs (PWID), especially those experiencing homelessness.
  • Barriers to testing and treatment are significant for this vulnerable population.
  • Mobile medical units (MMUs) offer a potential solution to improve access to care.

Purpose of the Study:

  • To evaluate the effectiveness of a simplified HCV testing and treatment algorithm delivered via MMU.
  • To assess integrated care for unhoused PWID in an urban setting.
  • To compare MMU care with usual care for HCV treatment initiation and outcomes.

Main Methods:

  • A pragmatic, randomized controlled trial was conducted with 201 PWID who tested positive for HCV antibody.
  • Patients were randomized to either a simplified MMU care model or usual care.
  • Primary outcome: HCV treatment initiation within 6 months; secondary outcomes: treatment completion, sustained virologic response (SVR12), and medication-assisted treatment initiation.

Main Results:

  • HCV treatment initiation was 33% in the MMU group versus 24% in the usual care group (not statistically significant).
  • Treatment completion and SVR12 rates were higher in the usual care group but not statistically significant.
  • MMUs improved treatment initiation speed but faced challenges with patient retention and follow-up.

Conclusions:

  • The MMU model shows promise for rapid HCV treatment access but requires further optimization.
  • Overall treatment initiation, retention, and cure rates were low in unhoused PWID.
  • Developing effective test-and-treat strategies is crucial for HCV elimination in this population.