Author: Babu Entoor Ramachandran, Sanjay Sarin, Sonjelle Shilton, Jessica Markby Preetishirin Katapur,Navneet Tewatia, Aylur Kailasom Srikrishnan

Theme: Models of Care Year: 2019

Background: In Manipur, a North-Eastern state of India, high prevalence of HCV due to injecting
drug use is well documented. Furthermore, lack of an established HCV care in the public sector,
makes access to diagnostics and treatment very challenging in this hill state.
Description of model of care/intervention: To address these gaps, FIND in collaboration with YRG
CARE has launched a decentralized HCV care for high risk groups in Manipur, India. In this
demonstration study, screening for HCV is being performed using rapid diagnostic tests (RDTs) at
four integrated care clinics (ICCs) where opioid substitution therapy (OST) is provided, and
confirmation of infection is being carried out using GeneXpert at 2 sites. Decentralised free of cost
treatment is also being offered at both the OST and Xpert sites. The proportion of participants that
complete each step in the HCV care cascade will be assessed as part intervention.
Effectiveness: Between January-March 2019, 1554 PWIDs (7% female and 93% male) have been
screened at OST sites with the median age being 33 years, and 807 (52%) of those tested found antiHCV positive. Of those who were found HCV sero-positive, 658 (82%) were successfully referred for
confirmatory testing out of which 530 (66%) were HCV RNA positive on Xpert. Within those with
confirmed HCV infection, 33% were coinfected with HIV and a total of 360 (68%) of those with
confirmed HCV infection were initiated on treatment.
Conclusion and next steps: A hub and spoke model of HCV testing using RDT screening at OST sites
and referral for confirmatory testing using Xpert has demonstrated good retention of PWID in the
HCV care cascade in Manipur. Outcomes of this study are expected to scale up of the model within
Manipur and provide data for replication in other states of India and the Asia Pacific region.

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