Estimation of the Cascade of HCV Testing, Care and Treatment Among Active PWID Who Attend Four Harm-Reduction Centers in Catalonia (HepCdetect II Study)

Author: Folch C, Saludes V, Antuori A, Ibáñez N, Reyes-Ureña J, Majó X, Colom J, Casabona J Martró E

Theme: Epidemiology & Public Health Research Year: 2018

In Catalonia, approximately 6000 people who inject drugs (PWID) attend the
harm-reduction center (HRC) network. While most HRC offer the rapid HCV
antibody test, PWID still face numerous barriers to access healthcare services.
We aimed to estimate key stages of the HCV cascade among PWID.
A cross-sectional study of active PWID was performed in 2016-17 in four HRC.
A convenience sample of 410 participants was tested for both HCV antibodies
(rapid test) and RNA (dried-blood spots –DBS–; 96.1% sensitivity, 100%
specificity). Self-reported behaviors, testing practices, current status, linkage to
care and treatment were recorded by HRC staff. The proportion of antibody
screened and antibody positive was referred to all participants. The proportions
of treated and cured were referred to the total number of HCV-RNA positive or
cured by treatment. These proportions were applied to the total population of
PWID attending these four centers (N=2258).
Overall, 85.4% were men, average age of 40 years and 17.7 years of injection.
Among the 2258 PWID attending HRC, 94.3% (n=2130) were previously HCV
screened, 79.8% (n=1802) antibody positive, and 65.4% (n=1477) HCV-RNA
positive or cured with treatment. Among the latter, 33.1% (n=488) had ever
started treatment, and 23.5% (n=347) had been cured by treatment. According to
DBS testing results it was estimated that 1321/2258 (58.5%) were still living with
HCV and in need for treatment, 35.9% being unaware of it.
This pilot study highlights the potential benefit of: i) DBS testing at HRC to
improve diagnosis rates of viremic infection, and ii) decentralized treatment in the
HRC setting to improve treatment rates. This methodology will be used to
estimate the HCV cascade among PWID in the whole region of Catalonia and
generate crucial data for the recently developed Catalan Hepatitis C Plan in order
to achieve WHO elimination goals.
Disclosure of Interest Statement: EM is an advisory board member and has
received research grants, as well as travel sponsorship and personal fees from
Gilead as speaker in meetings. This study was partly funded by the competitive
Fellowship Program from Gilead Spain (grant number GLD16-00135), but Gilead
had no role in study design, data collection and analysis, decision to publish, or
preparation of the abstract.
This study was also funded by public grants number PI15/000284 (Instituto de
Salud Carlos III/FEDER, European Union) and CPII15/00028 (Miguel Servet II,
ISCIII/FSE, European Union).

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