HCV RNA Point-of-Care Testing to Measure HCV Prevalence and Incidence Among Service Users of an Integrated Supervised Consumption Service in Toronto, Canada

Author: Bernadette Lettner Kate Mason Zoë Greenwald Sushi Rosborough Jordan Feld Jeff Powis

Theme: Epidemiology & Public Health Research Year: 2022

Rapid point-of-care (POC) hepatitis C virus (HCV) diagnostics and the expansion of supervised consumption services (SCS) offer an opportunity to increase access to HCV testing for people who inject drugs. We aim to measure HCV prevalence and incidence using HCV RNA POC testing within an SCS co-located at a community health centre.
POC HCV RNA testing was offered by a nurse within the SCS using the Cepheid GeneXpert platform (capillary blood sample; quantitative viral load result in ≤60 minutes). At baseline, those testing positive were immediately linked to onsite HCV treatment. Those testing negative were offered POC HCV RNA testing at 3-month intervalsfor up to 4 visits. We report HCV prevalence at baseline and estimate HCV incidence during up to 15 months of follow-up.
We enrolled 124 SCS clients: mean age 41 years, 65% male, 68% reported daily injection drug use, and 73% unstable/no housing. At baseline, 54 participants tested HCV RNA+ (HCV prevalence = 44%) and 70 tested HCV RNA-, of whom 37 returned for follow-up and 10 incident HCV infections were observed. The HCV incidence rate was 34.4 cases per 100 person years at risk (95% CI: 18.5 – 63.9) and the cumulative HCV incidence was 39% up to 15 months (Figure 1). Among those HCV RNA positive at any point (n=64), 43 were linked to care (67% of diagnosed), 29 initiated treatment via the co-located HCV program (67% of linked to care) with 25 confirmed SVR (86% of treated).
High rates of HCV RNA prevalence and incidence demonstrate that the SCS serves a high-risk population for HCV transmission. Interest in testing was high, as was treatment engagement. Rapid HCV RNA testing positions SCS as a point of integrated HCV care access, allowing for increased HCV testing/treatment uptake among people who inject drugs.
Disclosure of Interest Statement:
This study was supported by a grant from Gilead Sciences and in-kind support from Cepheid.

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