Community-based interventions for hepatitis C virus elimination among people who use drugs in Shanghai, China

The prevalence of hepatitis C virus (HCV) infection among people who use drugs (PWUD) in China remains high, yet diagnosis and treatment rates are low. Strategies are urgently needed to achieve the World Health Organization's goal of eliminating HCV as a public health threat by 2030.

To improve HCV diagnosis and treatment rates among PWUD in Pudong New Area, Shanghai, China.

A non-randomized controlled intervention study was implemented among individuals with a substance addiction history in Pudong New Area, Shanghai, China. Three models were explored in our study. In the Self-Referral (SR) model, HCV antibody-positive individuals relied on their own initiative to seek medical services. In the Standard Intensive Referral (SIR) model, managerial supervision was strengthened. The Active Intensive Referral (AIR) model placed greater emphasis on managerial proactivity, enhancing screening and treatment for high-risk populations.

A total of 3926 PWUD from 36 communities in Pudong New Area underwent rapid HCV antibody testing in the SR model. These numbers were 1973 and 191, respectively, in the SIR and AIR models. Only 18.9% population completed HCV RNA testing in the SR model compared with 100.0% in both the SIR and AIR models (P < 0.001). Overall, 70/146(47.9%) PWUD in the SR model were identified with HCV RNA, consistent with the SIR and AIR models [339/916(37.0%) and 74/191(38.7%), P > 0.05]. In terms of treatment, 47/74(63.5%) of patients in the AIR model initiated treatment, significantly higher than the 15/70 (21.4%) in the SR model and 73/339 (21.5%) in the SIR model (P < 0.001). Genotype 3, particularly subtype 3b, was the most prevalent genotype among PWUD in our study, respectively accounting for 23/38 [60.5%] in the AIR model and 112/166 [67.5%] in the SIR model. In the AIR model, all participants received a liver stiffness test. Fifty-two (27.2%) patients had a liver stiffness of more than 12.5 kPa. One hundred and eighty-one persons completed the questionnaire in the AIR model. The results revealed that few people had high educational attainment. More than half (52.5%) of the population had no stable marital relationship.

A multidisciplinary community-based approach significantly improved HCV diagnosis and treatment among PWUD. Despite limitations, the AIR model may represent a promising approach to improving the HCV care cascade among PWUD and could potentially contribute to China's efforts to optimize cascade management for hepatitis C elimination among specific high-risk populations.