Accessible Care Model Improves Outcomes in Patients With HCV Who Inject Drugs

Offering accessible and non-stigmatizing care can significantly improve outcomes in people who inject drugs (PWID) who are infected with hepatitis C virus (HCV), according to a study published in JAMA. The study wasconducted by investigators from Weill Cornell Medicine, New York-Presbyterian, NYU Grossman School of Medicine, and the CUNY Graduate School of Public Health and Health Policy.¹

According to National Institutes of Health (NIH) estimates, between 70% and 90% of individuals in the United States who have injected drugs for 10 years or more are infected with HCV.²

The NIH noted that successfully treating the virus in injection drug users requires a collaboration between health care providers and individuals with expertise in caring for substance users. It is crucial to help HCV-positive PWID gain access to treatment, which can be difficult because the stigma surrounding injection drug use may stop some of them from seeking medical care, according to the researchers.

Usual care facilities are frequently not conducive to, or may openly reject PWID, the study noted. Traditional health care clinics may require PWID to stop using injection drugs to gain access to treatment, which the study authors said is unnecessary and may prevent them from seeking care.

The single-site randomizedclinical trial was conducted from July 2017 to March 2021 at the Lower East Side Harm Reduction Center in New York City. Logistical challenges may prevent some PWID from accessing traditional care settings because they may be homeless or lack transportation to a clinic, causing them to miss appointments and get dropped from care.

Accessible care treatment centers, similar to the one used in this study, frequently have walk-in hours and will contact patients who miss appointments. The investigators said that the most significant benefit of the Lower East Side Harm Reduction Center appeared to be flexibility and comfort with the site.

The investigators enrolled 167 adult patients who were HCV RNA-positive and had who injected drugs in the past 90 days. Among the participants, the average age was 42 years, 77.6% were male, 4.8% were Black, 32.1% White, and 58.5% Hispanic.

Patients were randomized 1:1 to receive either accessible care treatment at a syringe service program or standard care via facilitated referral. The primary study outcome was HCV cure, measured by sustained virologic response. Patient follow-up continued for 1 year post study enrollment.

The HCV cure rate was found to be 86% for both cohorts who completed treatment. The study found that 67.1% of those enrolled at the syringe service program completed treatment versus 22.9% among those administered usual care.

The investigators concluded that the low threshold, non-stigmatizing HCV treatment program was associated with significantly higher rates of cure.

“In this randomized clinical trial, among people who inject drugs with hepatitis C infection, significantly higher rates of cure were achieved using the accessible care model that focused on low threshold, colocated, destigmatized, and flexible hepatitis C care compared with facilitated referral,” the study authors wrote. “To achieve hepatitis C elimination, expansion of treatment programs that are specifically geared toward engaging people who inject drugs is paramount.”

References

1. Eckhardt B, Mateu-Gelabert P, Aponte-Melendez Y, et al. Accessible Hepatitis C Care for People Who Inject Drugs: A Randomized Clinical Trial. JAMA Intern Med. Published online March 14, 2022. doi:10.1001/jamainternmed.2022.0170

2. Edlin BR, Carden MR, Ferrando SJ. Managing Hepatitis C in Users of Illicit Drugs. Curr Hepat Rep. 2007;6(2):60-67. doi:10.1007/s11901-007-0005-8