Results of a hepatitis C microelimination project in an addiction treatment center

patients on opioid substitution therapy constitute a group with a high burden of hepatitis C and candidates for interventions aimed at microelimination.

to analyze the baseline prevalence of both previous contact and/or active infection, measure the response to current treatment provided through a simplified circuit and estimate the impact of this intervention on the reduction of the proportion of the viremic population.

people affiliated to an addiction treatment center underwent an in situ diagnostic sequence using saliva serological screening and viremia quantification with a dry blood spot test. Viremic patients were linked to care and treatment, which was administered in the first single appointment with pan-genotypic direct-acting antivirals. The McNemar test was used to compare the proportion of active infection before and after intervention.

with a participation rate of 99.2 %, the seroprevalence for hepatitis C was 44.6 % (115/258) while active infection was present in 20.9 % of seropositive individuals (24/115). The response rate to treatment was 54.2 % by intention-to-treat and 61.9 % by per-protocol analysis. Successful treatment of 13 patients resulted in an estimated global reduction of the active infection rate from 9.3 % to 4.3 % (p = 0.0002), for a theorical scenario with no reinfections. By adjusting for the known reinfection rates, the prevalence of active infection also decreased to 4.2 % for individuals without assumed recent drug use (p = 0.0074), but no changes were found for estimates in patients with a supposed recent drug use (p = 0.2632).

focused efforts targeted to this high-risk group, including both screening and treatment initiatives, can potentially reduce the prevalence of active hepatitis C infections.