Hepatitis c virus care cascade among people who inject drugs in Puerto Rico: Minimal HCV treatment and substantial barriers to HCV care

Author: Yesenia Aponte-Meléndez, Pedro Mateu-Gelabert, Benjamin Eckhardt , Chunki Fong, Adriana Padilla , Eric Maldonado-Rodriguez, Wanda Trinidad-Martinez, Nancy Agront

Theme: Epidemiology & Public Health Research Year: 2023


People who inject drugs (PWID) are at high risk of being infected with hepatitis C in Puerto Rico, yet data on the hepatitis C virus (HCV) care among PWID in Puerto Rico is scarce. In this study, we describe the HCV care cascade among PWID as well as identify gaps and barriers to HCV care in Puerto Rico.


Participants (N=150) were recruited using respondent-driven sampling. Information of prior HCV testing, linkage to care, treatment and barriers to HCV care were collected using face-to-face structured interviews. Dried Blood Spot specimens were collected from participants and sent to laboratory for HCV Ab and RNA testing using Luminex assays. The cascade of care was estimated from self-reported information collected from the study survey. Additionally, study’s HCV test results were compared with self-reported information on prior HCV status.


Most participants, 126 of 150 (84%) reported prior lifetime HCV Ab screening, with 65 (43%) reporting being HCV Ab+ and 46 (31%) ever receiving HCV RNA confirmatory testing; 38 (25%) were linked to care; 12 (8%) initiated HCV treatment; and 5 (3%) achieved sustained virologic response (SVR). Study test results indicated that 109 (73%) participants were HCV Ab+ and 79 (53%) were HCV RNA+. Barriers to HCV care included concerns about treatment-related side effects, transportation access, low perceived risk of HCV infection, substance use restrictions to HCV treatment, health insurance coverage, stigma toward PWID in healthcare settings, lack knowledge about HCV treatment sites, and fear of HCV status disclosure.

This study provides insights on the HCV cascade of care among people who inject drugs in Puerto Rico for the first time and highlights limited testing, diagnosis, treatment uptake and barriers to care. Efforts to improve HCV care along all stages of the cascade and diminish barriers are needed.

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