Treatment of Hepatitis C (HCV) at an Opioid Agonist Therapy Clinic in Stockholm – Enhancing the HCV Continuum of Care

Author: Per-Erik Klasa, Isabell Lillieborg, Martin Kåberg, Martin Kåberg

Theme: Clinical Research Year: 2023

People with opioid agonist therapy (OAT) represent a population with an increased hepatitis C (HCV) prevalence. Recent studies among people with OAT confirm promising results regarding HCV treatment outcomes and levels of reinfection. HCV treatment in this populations is essential to reach the WHO goal of eliminating HCV as a major public health threat by 2030.

Prima Maria OAT clinic, located in central Stockholm, provides OAT for approximately 450 patients. The majority have a history of injection drug use. In January 2018, psychiatrist-led HCV treatment was initiated, with remote consultation support from the local infectious diseases clinic. All OAT staff participated in HCV specific education, including the INHSU open access on-line learning modules. To evaluate HCV treatment outcomes, we examined sustained virological response (SVR) and reinfection rates between January 2018 and December 2022.

By June 2022, 133 participants had initiated HCV treatment trough weekly administrations or directly observed treatment. Of these, 72% were men and overall mean age was 46.3 years. Six participants were re-treated, giving a total of 139 treatment initiations. All were HCV RNA negative at end-of-treatment (EOT) and 123/139 (88%) reached SVR (Figure 1). A total of 11 reinfections post SVR were noted, resulting in a reinfection rate of 7.3/100 person years (95% CI 4.1-12.9).

In this study we noted great HCV treatment results and a manageable level of reinfections. Bringing HCV diagnostics and treatment to an OAT clinic constitutes a good example of enhancing the HCV care cascade. Furthermore, HCV treatment education for psychiatrists, addiction specialists and staff at OAT clinics makes HCV continuum of care more sustainable, as specifically noted during the COVID-19 pandemic. This model of care, with HCV treatment by psychiatrists, on-site at OAT clinics, has now successfully been implemented at other OAT clinics in Stockholm.

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