Strategies of hepatitis C virus elimination for people who inject drugs receiving opioid agonist therapy in the era of direct-acting antivirals

Increased uptake of hepatitis C virus (HCV) treatment among people who inject drugs (PWID) is critical to achieve HCV elimination goals. This study attempted to observe the influence of different referral strategies among HCV-infected PWID for direct-acting antivirals (DAA). From January 2019 to November 2020, approximately 190 PWID regularly received opioid agonist therapies (OAT) in the drug addiction rehabilitation clinic of our institute. Among these, those with positive anti-HCV were further referred to our hepatology clinics for HCV viremia screening and treatment. According to physician involvement, referral strategies were divided into three models including patient self-intention referral (SR); intensive referral (IR) where patients were referred by clinicians; and fast-intensive referral (FIR) where patients were referred by clinicians with a fast-screening and easy-treatment program. A total of 121 HCV-infected PWID were enrolled and 71 (58.7%) of them received the referrals: 16 (22.5%) in the SR model, 36 (50.7%) in the IR model, and 19 (26.8%) in the FIR model. Monthly average referred patient number was 2.7 people in the SR model, 2.8 people in the IR model, and 4.8 people in the FIR model, respectively. Among the 71 referred patients, 64 (90.1%) had detectable HCV viremia with genotype distributions being genotype 1a (G1a) in 23 patients (35.9%), G1b in 10 (15.6%), G2 in 5 (7.8%), G3 in 6 (9.4%), and G6 in 20 (31.3%). Except for three patients who refused treatment, 61 patients underwent and completed DAA treatment including 35 patients for Maviret, 15 for Epclusa, 9 for Harvoni, and 2 for Zepatier. Excluding three patients who were lost to follow-up and one becoming reinfected, 57 (93.4%) eventually achieved a sustained virologic response. Although HCV treatment uptake among PWID in this hospital-based setting remained suboptimal, the FIR model with a quick-to-screen and easy-to-treat program was proven practicable in the hospital setting. Further innovative strategies are required to reach all HCV-infected PWID receiving OAT.