HEPATITIS C VIRUSMICRO ELIMINATION IN SUSSEX: INTERIM RESULTS FROM THE END C STUDY

Introduction

As we approach the final stages of Hepatitis C virus (HCV) elimination, we are left with increasingly more complex individuals to treat. Based on our initial novel “one stop” community HCV care model in Brighton focussed at people who use drugs (ITTREAT) and people who are homeless, we set up the END C study to achieve HCV micro elimination across Sussex.

Methods

END C Study (2019-2023) is based at multiple homeless sites across Sussex. We provide an integrated service that includes blood borne virus (BBV) testing (point of care HCV RNA testing), assessment of alcohol/drug use/liver fibrosis and HCV treatment. We are using innovative strategies to encourage linkage to care. Primary outcome measure is sustained virological response SVR12 (intention to treat [ITT]). Secondary outcomes include health related quality of life (HRQoL), Short Form Liver Disease Quality of Life (SFLDQoL), Short Form Health Survey (SF-12v2), and EQ-5D-5L, assessed at end in those achieving SVR12; cost per HCV case detected and cost per HCV cure. All data are prospectively collected.

Results

To date, 336 individuals have been recruited, 79% being male with a mean age of 44.5 ± 10.8 years. Around three-fifths (62%) were currently drinking alcohol, 25% were currently injecting drugs, 30% were on opioid agonist treatment and 259 (82%) individuals were currently homeless with 58 (18%) currently housed. Comparing currently homeless vs currently housed data as follows: age (years) 44.2 ± 10.8 years vs. 45.8 ± 10.6 (p=0.3070), current drinking 58% vs. 81% (p=0.0012), current IDU 26% vs. 21% (p=0.4303), HCV PCR positivity 23% vs. 34% (p=0.0805) respectively. Uptake of transient elastography was 77% with 45% having ≥ F2 fibrosis (LSM>7.1kPa) and 25% having cirrhosis (LSM>12kPa). Overall, prevalence of positive HCV PCR was 26% (n=86). of those with a positive PCR, 69% (n=59) have commenced HCV treatment thus far. of those commencing HCV treatment 39 people have completed treatment with an SVR12 being 85%. Patient reported outcome and health economic data is on-going.

Conclusion

Interim results from END C study confirm the easy reproducibility of our earlier community model. Despite being a vulnerable and disenfranchised cohort, early END C data shows excellent service uptake and SVR12 results.

References

Hashim et al. Chronic liver disease in homeless individuals and performance of non-invasive liver fibrosis and injury markers: VALID study. Liver Int. 2021;1– 12 . O’Sullivanet al. ITTREAT Hepatitis C service for people who use drugs: Real-world outcomes. Liver Int. 2020; 40: 1021– 1031.