Universal On-Site HCV-RNA Screening is Warranted Among Active PWID Who Attend Harm Reduction Centres in Catalonia, Spain (HepCdetect II Study)

Author: Saludes V, Folch C, Antuori A, González N, García D, Anoro M, Ibáñez N, Majó X, Colom J, Casabona J, Martró E

Theme: Epidemiology & Public Health Research Year: 2018

Background: In Spain hepatitis C virus (HCV) diagnosis rates may be too low to
allow elimination by 2030 due to diagnostic burn-out. In Catalonia, the antibody
testing coverage among PWID who attend harm-reduction centers (HRC) is
94.3%. However, linkage to care for HCV-RNA confirmation is limited. We aimed
to implement on-site HCV-RNA testing at the HRC with the largest number of
PWID in Spain, to assess their awareness of disease status and linkage to care
of treatment candidates.
Methods: HCV-RNA testing from dried-blood spots (DBS) was offered to an
opportunistic sample of active PWID (N=275). Laboratory DBS results were
delivered to the center within 1-2 weeks. Results delivery to participants and
referral to care was recorded. Additionally, an epidemiological questionnaire was
Results: HCV viremic infection was detected in 162 participants (58.9%), 69
(42.6%) being unaware of it. There were no socio-demographic or bio-behavioral
factors associated with unawareness of viremic infection. Conversely, 9.5% of
participants erroneously believed that they were currently HCV-infected. Overall,
139 participants (50.5%) were unaware of their HCV status (either viremic or nonviremic). HCV-RNA results were successfully delivered to 75.3% viremic
individuals, of whom 83.6% were referred to care (most of the rest were already
linked to care). A subgroup of 32 (19.8%) viremic participants was followed up for
6 months after results delivery. Nine reached primary care, and while six reached
the specialist another four had done so before participating in the study, none of
them started treatment within the follow-up period.
Conclusion: Given the high proportion of individuals unaware of their HCV
status, this on-site HCV-RNA testing strategy should be scaled-up to all PWID
who attend the HRC network in Catalonia. Additionally, the limited linkage to care
and treatment access even after receiving HCV-RNA results at the HRC warrants
future implementation of on-site antiviral treatment.
Disclosure of interest statement: EM is an advisory board member and has
received research grants, as well as travel sponsorship and personal fees from
Gilead as speaker in meetings. This study was partly funded by the competitive
Fellowship Program from Gilead Spain (grant number GLD16-00135), but Gilead
had no role in study design, data collection and analysis, decision to publish, or
preparation of the abstract. This study was also funded by public grants number
PI15/000284 (Instituto de Salud Carlos III/FEDER, European Union) and
CPII15/00028 (Miguel Servet II, ISCIII/FSE, European Union).

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