New care model delivers hepatitis C treatment to the most vulnerable

Breakthrough treatments introduced over the past decade have transformed hepatitis C from a chronic and potentially fatal infectious disease to a treatable disease. But these drugs are often beyond the reach of those most vulnerable to the virus: people who inject drugs and people who lack stable housing.

To address this gap, UCSF researchers have developed a new care model that could provide people with medications as soon as they are diagnosed. Community-based testing and treatment approaches are just as effective for people who inject drugs, many of whom are homeless, as clinic-based hepatitis C treatments are for the broader population.

Their research was published in JAMA Network Open, is the first project in the United States to evaluate such a program outside of a health care setting. The study found that 92% of patients who completed treatment and had follow-up blood draws had undetectable hepatitis C virus (HCV) levels. Eighty-four percent had a sustained virological response, meaning they were cured three months after treatment.

“Providing hepatitis C treatment at the time of diagnosis can streamline care and save time and money,” said the study’s first author, Meghan D. Morris, MPH, associate professor in the Department of Epidemiology at UCSF. Morris said. Biostatistics. “By offering our ‘one-stop’ model in non-clinical settings, it also addresses a major barrier that prevents people who inject drugs and individuals from marginalized communities from accessing treatment: stigma.”

About 2.4 million Americans have hepatitis C, an insidious liver disease caused by a blood-borne virus. The disease causes severe liver damage and kills about 15,000 people each year, according to federal statistics. Before the COVID-19 pandemic, hepatitis C virus killed more Americans than all other reportable infectious diseases.

More than 80% of new hepatitis C infections are associated with the sharing of needles and syringes used to inject drugs, and the increase in new cases corresponds to an increase in opioid use in recent years. The virus can also be spread through sex and childbirth.

New treatments for hepatitis C, first introduced a decade ago, have changed the course of the disease, with the vast majority of patients treated on a two- to three-month course being cured. Relapse after treatment is extremely rare (about 1%), but reinfection with HCV is possible.

However, only about one-third of patients receive treatment within a year of being diagnosed with the highly contagious disease, according to the Centers for Disease Control and Prevention.

“Despite curative treatment, nearly half of people with hepatitis C are unaware of it, and only a minority of those diagnosed receive treatment. Our study population was even less likely to be diagnosed and cured because They encounter many barriers throughout the hepatitis care cascade, including navigating the health care system and experiencing medical stigma,” said Jennifer C. Price, Ph.D., associate professor in the Division of Gastroenterology and Hepatology at UCSF and senior author of the study. explain.

As part of the No One Waits, or NOW, study, UCSF researchers used street campaigns to recruit people to get tested in neighborhoods near transportation hubs and offered small cash payments as incentives. They also provide general health information, COVID vaccinations, sterile syringes and hot meals.

The team recruited 87 people, about 80% of whom were injecting drug users and 61% of whom were homeless. Their average age is 48 years old.

They received a combination of sofosbuvir and velpatasvir, which is sold under the brand name Epclusa by Gilead Sciences, the study’s sponsor. Participants received a two-week starter pill, to be taken daily for 12 weeks. They returned every two weeks after that for more medication, which the researchers gave to those who didn’t show up.

Although San Francisco resident Claudette Blueford, 62, tested positive for hepatitis C several years ago, she did not seek treatment. She explained that as someone who uses intravenous drugs and is homeless, this is not a priority.

Bruford initially joined the study to get paid. When researchers explained the seriousness of the disease, she began to realize the benefits it had on her health.

No participants experienced adverse events or died. But scarring and collapsed veins from years of drug abuse left a quarter of the people in the study unable to have their blood drawn to check whether they were healed. Bruford is one of those believed to have been cured.

“It’s easy to get rid of it,” she said. “You just need to take some medicine.”

Bulford found stable housing midway through the study and has since reduced her drug use.

“You know it’s hard for drug addicts because they don’t want to hear it,” she said, adding that the researchers treated her with kindness and respect. “I started listening to what they were saying. It made sense and I was involved in it.”

The researchers say the results show the potential for providing hepatitis C testing and treatment programs in settings such as shelters, libraries and food-sustainment programs.

The authors note that the current two-step testing process (antibody screening and RNA testing) for diagnosing hepatitis C remains a hurdle, but they hope their findings will encourage point-of-care RNA testing to soon be approved in the U.S.