Innovative Community-Based Strategy to Eliminate HCV Among People Who Inject Drugs in Vietnam

Author: Nicolas Nagot Minh Khue Pham Thanh Binh Nguyen Vinh Hai Vu Thi Hong Tran Catherine Quillet Roselyne Vallo Thi Huong Duong Thi Hai Oanh Khuat Thi Tuyet Thanh Nham Delphine Rapoud Thi Nhu Quynh Bach Thi Hai Oanh Jonathan Feelemyer Laurent Michel Peter Vickerman Hannah Fraser Laurence Weiss Maud Lemoine Karine Lacombe Don Des Jarlais Jean-Pierre Moles Didier Laureillard

Theme: Clinical Research Year: 2022

Background: Elimination of HCV among people who inject drugs (PWID) requires innovative
strategies that encompass the whole screening, care and prevention pathway. We aimed to assess
the efficiency of a strategy consisting of community-based respondent-driven sampling (RDS) survey
as mass screening, together with simplified hospital-based care and prevention of reinfection
supported by community-based organisations (CBO) in Haiphong, Vietnam.
Methods: Adults currently injecting heroin were eligible to participate in a RDS survey implemented
in two CBO offices, where participants were screened for HCV. Those with detectable HCV RNA were
referred to local clinics in three public hospitals. Patients were treated with 12-week
sofosbuvir/daclatasvir, plus ribavirin if cirrhosis, and followed-up 12 and 48 weeks post-treatment.
Using a case-management approach, CBO members provided harm reduction counselling, support
for linkage to and retention in care, and treatment adherence support. The primary endpoint was
the rate of HCV cure at 48 weeks.
Results: Among the 1344 RDS survey participants, 875 had detectable HCV RNA. Median age was 44
years, 96% were male, 44% were on methadone and 36% were HIV-infected. Overall, 78% of
participants started HCV treatment and 92% had confirmed sustained virological response at 12-
weeks post-treatment (SVR12). At week 48, 96% of participants who attended the visit were cured.
Among PWID identified with HCV RNA at RDS survey, 66% (95%CI: 63-69) were cured at 48 weeks.
After SVR12, the reinfection rate was 4/100 person-years (95%CI: 2-7). Younger age (<36 years), no
regular place to stay, not holding a health insurance card (not required for treatment), and not being
engaged in either addiction or HIV care were independently associated with not having initiated
Conclusion: This community-based strategy, addressing all steps from mass HCV screening in the
community to care and prevention of reinfection, stands as a promising tool to reach HCV
elimination among PWID.
Disclosure of Interest Statement: No conflicts of interest to report.

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