Theme: Clinical Research Year: 2019
Background: In Vienna there are about 6.500 PWIDs on opioid substitution therapy (OST). Our aim
was to eliminate HCV in this population by a combined screen-and-treat strategy.
Methods: Study part 1: A considerable subgroup of PWIDs with HCV are reluctant to attend tertiary
care centers. Next to poor adherence, they are unlikely to maintain a regular drug intake if provided
with DAAs for self-administration. Therefore, HCV treatment was performed as “directly observed
therapy” (DOT) since 2014: Patients received DAA together with OST under supervision of medical
staff at a pharmacy or low-threshold facility.
Study part 2: In Vienna, every PWID on OST has to renew her/his long-term OST prescription at one
of nine health authority centers once a month. At these centers all PWIDs are offered saliva-based
testing for anti-HCV antibodies (OraQuick®) – followed by HCV-RNA PCR in case of a positive antiHCV(+) result. HCV-RNA(+) PWIDs are then referred to a low-threshold facility for initiation of DAA
therapy.
Results: Study part 1: Using the concept of DOT adherence to therapy was excellent: Only 0.1% of
scheduled dates for DAA intake together with OST were missed. So far, 232 of 233 (99.6%) PWID who
finished treatment and 12 weeks of follow-up have achieved sustained virologic response (SVR12).
During further follow-up reinfection was recorded in 15/232 (6.5%) patients.
Study part 2: Screening at health authority centers was well accepted. During the first month of the
project 381 PWIDs were included: 177/381 (46.5%) showed anti-HCV(+) and 69/381 (18.1%) were
viremic.
Conclusion: The concept of DOT is highly effective in PWIDs on OST with a high risk of non-adherence
to DAA therapy. HCV-Screening of PWIDs at public institutions is well accepted and has the potential
to identify a considerable number of unknown HCV cases.
Disclosure of Interested Statement: Part of this work was supported by Gilead Sciences