Community-based point-of-care treatment for hepatitis C diagnosis improves outcomes

Successful hepatitis C virus (HCV) treatment outcomes and sustained virological response (SVR) were achieved 12 weeks after initiation of treatment at diagnosis in a non-clinical setting among homeless people and people who inject drugs (PWID).

Meghan Morris, PhD, of the Department of Epidemiology and Biostatistics at the University of California, San Francisco, and colleagues conducted a study, the results of which are published in JAMA Network Open Last month, looked at whether hepatitis C virus testing and treatment models might be effective in marginalized communities that otherwise cannot overcome barriers to testing and treatment.

Ideally, access to health care should not be hindered by inconvenience or barriers to travel. Unfortunately, many people around the world face challenges getting the health care they need. One specific area where access to health care is critical is the treatment of hepatitis C virus.

HCV is a viral infection that affects the liver and can cause serious health complications if left untreated. It is estimated that more than 70 million people worldwide are infected with hepatitis C, and a significant number of these people face difficulties in obtaining necessary treatment. Marginalized populations, including drug users, account for more than 80% of HCV infections in the United States. The incidence of hepatitis C virus infection has increased in the United States due to the opioid epidemic.

Traditionally, hepatitis C diagnosis and treatment has been concentrated in healthcare settings, making it difficult for individuals in remote or underserved areas to access appropriate care. Now, though, some care is moving toward community-based point-of-care treatment, which aims to bring care closer to those who need it.

Community-based point-of-diagnosis treatment involves integrating testing and treatment services into community settings such as primary care clinics, community health centers, and outreach programs. This approach eliminates the need for patients to travel to specialized medical facilities, increasing access to care and reducing barriers.

Community-based point-of-care treatment for hepatitis C diagnosis has several benefits. It allows for early detection and treatment, leading to better health outcomes. By bringing testing and treatment closer to the community, individuals are more likely to seek medical help at an earlier stage, increasing the chances of successful treatment and reducing the risk of complications.

Community-based treatment programs may help address the stigma associated with hepatitis C. Researchers say many people are hesitant to seek testing and treatment out of fear of being judged or discriminated against. By providing services in a familiar and non-threatening community setting, people may be more willing to seek help, which can help reduce the stigma surrounding the disease.

The widespread use of direct-acting antivirals (DAAs) has enabled better access to treatment and increased treatment compliance. Furthermore, the use of DAAs to treat HCV has pushed SVR/cure rates to 100%. Although clinical guidelines recommend treatment for all adults infected with HCV, low treatment utilization among marginalized populations, including drug users, remains a significant concern.

Morris and colleagues report results from No One Waits (NOW), a single-arm, non-randomized controlled trial designed to assess the feasibility, acceptability, and safety of delivering HCV treatment at the time of diagnosis in nonclinical community settings . The primary endpoint was SVR12 at or after week 12 of treatment. Secondary endpoints included undetectable HCV RNA at treatment completion. Discontinuation of treatment due to late exclusion criteria or adverse events was the measured safety endpoint.

Participants received HCV testing, diagnostic disclosure, and treatment in nonclinical settings. Participants were provided the Epclusa starter pack (sofosbuvir and velpatasvir) after disclosure of HCV RNA results. When feasible, they switched to 12 weeks of treatment with medications provided by their insurance.

The study enrolled 492 participants, of whom 50% tested positive for HCV antibodies and 111 participants (23%) were eligible for simplified HCV treatment. Of the participants who returned for RNA results (80%), 98% accepted and started treatment. Additionally, 79% of patients successfully completed 12 weeks of treatment. Among treated patients, 67% in the intention-to-treat group achieved SVR after 12 weeks of treatment. No adverse events, delayed exclusions, or deaths were reported during the study.

Findings indicate that the point-of-diagnosis treatment model used in this study reduced barriers to HCV treatment initiation and resulted in high levels of treatment initiation, completion, and cure. Simplified HCV treatment algorithms can enable non-HCV specialist healthcare providers to offer DAA treatment, while innovative approaches aim to lower barriers for drug users. The study highlights the model’s potential to expand hepatitis C testing and treatment efforts by reaching marginalized communities and furthering treatment.

Morris and colleagues emphasize the importance of scaling up HCV testing and treatment efforts to reach marginalized populations and overcome the barriers they face in accessing HCV treatment. The authors add, “With additional resources dedicated to improving HCV diagnosis, access to DAA treatment… as outlined in the U.S. National Hepatitis C Elimination Plan, our model could be replicated in other urban community settings and other co-localized services.” Domain Implementation.”