Theme: Clinical Research Year: 2018
Background: Treatment with Direct Antiviral Agents is safe and highly effective in People Who Inject Drugs (PWID). Unfortunately, most of PWID is Out Of Care (OOC). ‘Una regione senza la C’ is a project that aims to validate a territorial screening and referral network for PWID. Methods: 13 low threshold harm reduction services of Lazio were involved in contacting PWID, offering counselling about HCV and performing Rapid HCV Antibody salivary test. People with positive screening test were referred to the Infectious Diseases Clinic of Policlinico Tor Vergata for the engagement in care, through a reserved fast track. We report data collected from October 2017 to February 2018. Results: 4116 PWID received counselling, among them 517 agreed to be screened for HCV. HCV Rapid test resulted positive in 109/517 subjects (21%). 48/97 of the scheduled appointments at our Clinic were performed: Chronic hepatitis C was confirmed in 32/48 (67%) patients who were advised to start DAAs. Patients showed complex features: 65.6% is active drug user (15/21 multidrug); predominant genotypes were 1a and 3a (38% for each), resistance associated mutations were found in 15.6%, one-third was cirrhotic. Although more than 53% of population received HCV diagnosis more than 10 years ago, 84% (27/32) were naive to treatment. Only one of the HCV-positive PWID was HIV co-infected and 40% had a concomitant occult HBV infection. Latent TB infection was diagnosed in 2 patients. Conclusion: HCV seroprevalence amongst PWID was almost ten-fold higher than in the general population. The project has contributed to reveal that still a broad part of the PWID population is OOC. The network of health care professionals created, and the screening method used, have given the PWID an opportunity to start an accurate medical follow up; the high percentages of contacted and treated patients showed the efficacy of the procedures.
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