Theme: Models of Care Year: 2019
Background:
Sharing injecting equipment is the most common mode of hepatitis C (HCV) transmission, yet PWID
are often excluded from HCV treatment and have numerous barriers to healthcare. To combat risk
for HIV acquisition, HCV re-infection, and opioid overdose, models integrating comprehensive
medical treatment and harm reduction are needed to improve outcomes in PWID.
Description of model of care/intervention:
We collaborated with a pre-existing harm reduction drop-in center in Washington, DC to establish a
clinic that provides HCV treatment, opioid agonist therapy (OAT) and pre-exposure prophylaxis
(PrEP) for PWID. Prior to clinic initiation, no medical care was provided on-site; services included
syringe exchange, case management, showers, meals, and clothing. Key to the model’s success
were:
1) Culturally competent environment (leveraging existing relationship of the
organization in the community);
2) Low-barrier medical care (flexible scheduling, walk-in always available, no medical
restrictions based on drug use);
3) Collocation of services (treatment for HCV and OUD, PrEP and naloxone
dispensation by same provider, concurrent syringe-exchange, housing assessments);
4) Community health workers to provide testing, recruit patients, facilitate
transportation and visit adherence, and provide ongoing clinic engagement.
Effectiveness:
100 patients initiated HCV treatment. Medical visit adherence was high, sixty-six(66%) patients came
to all 3 on-treatment visits and 93% received the full 3-months of medication. Of 67 patients not on
OAT at time of engagement, forty-nine(73%) initiated collocated OAT. Seventy-three(73%) patients
were ever dispensed naloxone during medical visits. Twenty-three(23%) initiated PrEP.
Conclusion and next steps:
Creation of a low-barrier medical clinic embedded in a harm reduction organization facilitated high
uptake of HCV treatment, OAT, naloxone and moderate uptake of PrEP in a highly marginalized
population not linked to medical care. Models of care aimed at providing culturally competent,
integrated care are essential for eliminating HCV while addressing overall health in PWID.
Disclosure of Interest Statement:
Drs. Mathur, Kattakuzhy, and Rosenthal receive investigator grants to the University of Maryland,
Baltimore from Gilead Sciences, Inc. and Merck.