The Hepatitis C Free Balears Project: An hepatitis C model of care adapted to PWUD from the Balearic Islands, Spain


Author: Andrea Herranz Mochales, Lucía Bonet, Marita Trelles, Alicia R Rubí, Leticia Martín, Andreu Sansó, Joan Gelabert, Mercedes García Gasalla, Maria Buti, Àngels Vilella, Jeffrey V Lazarus

Theme: Models of Care Year: 2023

Background:

People who use drugs (PWUD) are a high-risk population for hepatitis C virus (HCV). In the Balearic Islands, Spain, PWUD often have difficulties accessing healthcare, impeding timely HCV diagnosis and treatment. Therefore, adapted models of care are needed. The Hepatitis C Free Balears project offers an alternative HCV model of care with simplified pathways tailored to PWUD.

Description of model of care/intervention:

Since April 2021, this model of care has been implemented in 21 addiction services centres, including four phases: 1) recruitment and on-site HCV screening using anti-HCV antibody tests (Oraquick®) and dried blood spot tests to confirm viremia (HCV-RNA); 2) linkage to specialist care; 3) treatment prescription via telemedicine; and 4) on-site monitoring of sustained virologic response (SVR) at 12 weeks after treatment and for reinfection monitoring after a year.

Effectiveness:

To date, of the 1,311 recruited patients, 423 (32%) were anti-HCV+ and 154 (12%) of the total were HCV-RNA+. Of those HCV-RNA+ (mean age 46.8 [SD: 8.97]), 112 (73%) were men, 133 (86%) were Spanish-born, 130 (84%) reported a previous HCV diagnosis, 30 (19%) reported previous HCV treatment, 26 (17%) were co-infected with HIV and 3 (2%) with HBV. Of those HCV-RNA+, 132 (86%) started treatment and 112 (85%) completed it. SVR12 monitoring tests were performed in 88 (79%) patients who completed treatment and 95% (n=84) showed undetectable HCV-RNA. Reinfection monitoring test after 1 year was performed in 6% of the total participants and resulted in 3 reinfections. Fourteen (1%) patients abandoned the project.

Conclusion and next steps:

The Hepatitis C Free Balears project has demonstrated that facilitating access to diagnostic tests, linkage to specialist care and HCV treatment, leads to high cure rates among PWUD. Routine HCV screening must be offered and performed in all the addiction services centres in order to achieve HCV elimination in this vulnerable population. 

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