Case Management to Improve Uptake for Screening and Therapy of Hepatitis C viral infection in People Who Inject Drugs.

Abstract

Introduction Hepatitis C viral infection (HCV) has become a curable disease due to the development of direct acting antivirals (DAA). Therefore, the World Health Organization (WHO) has set a target to eliminate HCV. The largest group at risk for HCV at present are people who inject drugs (PWID), especially in the western world. Due to various barriers, this risk group is still underserved for HCV. Our goal was to study if a case management policy could improve uptake for screening and treatment for HCV in PWID. Methods We performed a prospective, interventional cohort study, evaluating the effect of case management on screening and treatment for HCV in PWID in an opiate substitution treatment (OST) setting in Limburg (Belgium). The goal was to address the PWID at this setting and to provide all the steps of the continuum of care, proposed by Meyer JP et al. (Int J Drug Policy, 2015). The cohort existed of four groups of PWID: firstly, a large group who received methadone at their local pharmacy. A second large group received methadone at the OST setting. Thirdly a smaller a group who were active users in a needle exchange program. And finally a small group who were recruited after referral to the hospital (former PWID). Results The results are presented in Figure 1. In all of the groups more than 80% of the cases were screened, except in the pharmacy group: these presented only a few times a year in the OST setting which could explain the lower screening rate. However, when addressed, more than 85% of the PWID in the pharmacy group were tested. In our PWID cohort, approximately 29% was HCV RNA positive. From these chronically infected PWID, 62% were assessed for treatment. 95% of them were eligible for antiviral treatment. However, treatment could only be started within the Belgian reimbursement criteria (requirement of F3 or F4 Metavir fibrosis score). As such, 51% were ruled out for therapy at present and treatment was started in 43%. Conclusion Case management is an effective way to screen a well-defined cohort of high-risk individuals for HCV and also improves treatment uptake.