HCV screening in the treatment centers for people with addictions: lessons learned

Hepatitis C virus (HCV) infection still represents one of the most important causes of morbidity and mortality, particularly among subjects who use substances of abuse, revealing itself as a public health problem with significant implications. Today the availability of simpler diagnostic algorithms and of direct-acting antiviral therapies, make free screening for HCV advantageous, in terms of cost/benefit.The Italian Ministry of Health has therefore promoted a national screening project, with the aim of detecting the active HCV infections not yet diagnosed, increasing the possibility of early diagnosis and timely initiation of treatment, in order to both avoid complications induced by advanced liver disease and extrahepatic manifestations, and to interrupt the transmission of the HCV.In this context, after a short pilot study, since May 2022 a HCV screening program has been expanded to the whole Piedmont region. Patients invited to participate in the regional screening program include individuals of the general population born between 1969 – 1989, all patients accessing the Treatment Centres for People with Addictions (TCPAs) of the National Health Service (NHS), and the entire prison population.On the 31st December 2023, among the 24,991 TCPA patients identified for inclusion, 7,062 (28.3%) had been tested, 125 (0.5%) had refused the test, 462 (1.8%) had been excluded (as already diagnosed with active HCV infection), and 17,432 (69.4%) were still to be tested.The use of identical procedures for individuals from the general population and TCPAs clients highlighted differences between the groups which need to be considered when undertaking future planning. A higher level of attention to respect for privacy requested by TCPAs clients, the shortage of staff in the TCPAs, the introduction of a project-specific digital platform not integrated with the usual TCPAs’ data recording system, and difficulties in collaborating and communicating between the different actors involved in the process (i.e. TCPAs, testing laboratories, specialist centers for the diagnosis and treatment of HCV) represent the major obstacles to the success of the project in the TCPAs. Vice versa, the availability of rapid on site testing and a strong commitment from the director and staff proved so far to be the most important factors for increasing the testing in the TCPAs and encouraging the subsequent steps to pharmacological treatment, especially as regards those patients with addiction who are more resistant to screenings and more difficult to reach.In conclusions, when planning an intervention involving TCPAs it is necessary to keep in mind the peculiarities of the clients and integrate the new intervention with the activities and organization in place, in order to limit the negative impact on existing procedures and facilitate acceptance of the new intervention both by patients and by the staff involved in its promotion and implementation.