A novel hepatitis C intervention in Denmark to test and treat people who inject drugs
Background: Providing testing and treatment for the hepatitis C virus (HCV) for people who inject drugs (PWID) is critical in eliminating it, but reaching this population with traditional healthcare services can be challenging. Combining point-of-care (PoC) testing with peer support and counselling is a model of care (MoC) that can be effective for PWID. This study aims to investigate if a peer-led mobile van equipped with rapid PoC tests for HCV antibodies (Ab) and RNA could simplify testing and link PWID to care and treatment.
Methods: In Copenhagen, Denmark, a peer-led mobile service providing counselling, Ab testing (In-Tec™) and linkage to standard care was equipped with a PoC HCV-RNA finger-prick test (Xpert HCV Viral Load Fingerstick PoC assay, Cepheid). Eligible HCV-RNA+ individuals were offered assisted referral to a fast-track hospital clinic for evaluation and treatment, with peer support available if needed.
Results: From 1 May 2019 to 25 October 2021, 1013 people were tested for HCV-RNA and 10.2% (n=103) were positive. Nine additional individuals with HCV infection contacted the service to be linked to care. Of the 112 individuals with chronic HCV infection, 72.3% (n=81) were evaluated for treatment at the hospital clinic, of whom 86.4% (n=70) initiated direct-acting antiviral therapy and 3.7% (n=3) are waiting to initiate treatment. Major reasons for not being evaluated for treatment included being undocumented (38.7%; n=12) and being lost to follow-up (32.3%; n=10). Among those who initiated treatment, 20.0% (n=14) were connected to drug addiction treatment services. The peer-led service assisted all treated with communication with the hospital nurse, collection of treatment medicine and accompaniment to follow-up visits.
Conclusion: We found that a peer-led mobile PoC service is an MoC that can engage PWID in HCV testing and link them to treatment, even during the COVID-19 pandemic. We identified being an undocumented migrant as a major cause for not accessing care. This poses a challenge for HCV elimination in Denmark due to the risk of onward transmission. Next steps include engaging with health authorities to provide care for these migrants.