Patients with hepatitis C virus (HCV) who inject drugs are more likely to achieve HCV cure when using an accessible care model compared with a facilitated referral standard care model, according to study results published in JAMA Internal Medicine.
For the analysis, researchers conducted a randomized controlled trial (ClinicalTrials.gov Identifier: NCT03214679) at a harm reduction center with a syringe service program in New York, New York. Patients (N=165) with RNA-positive HCV who had been using illicit injectable drugs for at least 1 year, including in the previous 90 days, were enrolled in the study. Participants were randomly assigned to receive either accessible care or standard care. In the accessible care arm, patients (n=82) had on-site medical and laboratory appointments with flexible scheduling, medication dispensing, and a focus on nonstigmatized, low-threshold care. In the control arm, patients (n=83) were referred to an on-site HCV patient coordinator, who assisted with medical appointments, access to medications, and general supportive services.
The primary outcome was the proportion of patients who reached a sustained virologic response within 12 months of enrollment. The proportion of patients who achieved each step of the HCV treatment cascade was measured as a secondary outcome. The treatment cascade included referral to an HCV clinician, attendance of the appointment with an HCV clinician, laboratory testing, and therapy initiation.
Patients in the accessible care arm were significantly more likely to achieve sustained virologic response compared with patients in the standard care arm, at 67.1% and 22.9%, respectively (P< .001). While therapy, if initiated, was comparably efficacious for patients in either arm, patients receiving accessible care were much more likely to initiate treatment (78.0% vs 26.5%). For each step of the treatment cascade, patients in the accessible care intervention arm were 2 to 3 times more likely to achieve the step compared with patients in the control arm.
The study may have been limited by its single-center design and may not be generalizable to other areas of the United States, where harm reduction centers, insurance eligibility, and therapy coverage may not be as robust. The trial strongly supports the need to update the current practice model.
“The accessible care model presented in this article potentially provides a framework for developing novel treatment programs nationally and internationally that are specifically geared toward engaging, treating, and curing HCV in people who inject drugs,” the study authors noted.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Eckhardt B, Mateu-Gelabert P, Aponte-Melendez Y, et al. Accessible Hepatitis C care for people who inject drugs. JAMA Intern Med. Published online March 14, 2022. doi:10.1001/jamainternmed.2022.0170