Improving the model of care pathway for HCV between the drug care centres and their referral hospitals in Catalonia.

Background: In alignment with the Hepatitis C Elimination Plan of Catalonia issued in 2017, the Public Health Agency of Catalonia has been actively implementing strategies since 2009 to elevate Hepatitis C (HCV) screening and treatment among people who use drugs (PUDs). This communication aims to share Catalonia's strategy, among various approaches, to increment HCV screening and treatment rates among PUDs accessing drug services.
Methods: In 2021, an interdisciplinary team developed individualised protocols for each Drug Addiction Care and Monitoring Center (CAS) in Catalonia to enhance HCV screening and linkage to care for PUDs. This initiative primarily focused on the "test and treat" strategy and the integration of comprehensive services within each CAS, effectively creating a streamlined, one-stop-shop model. The screening procedures encompassed serological rapid tests, dried blood tests for viremia detection and conventional venous puncture methods. To evaluate the effectiveness of these protocols, a comprehensive monitoring plan was established, focusing on the pathways of HCV screening and treatment and the overall treatment cascade.
Results: As of December 2023, 44 out of Catalonia's 62 outpatient drug centres (CAS) have adapted and implemented this protocol. Screening was offered to  7,841 patients, where 93% (n=7,304) accepted testing. Among those tested, 23% (n=1,675) were identified as exposed/infected while 9% (n=650) exhibited viremia (RNA+). This constituted 39% of those exposed/infected. Until 2023, 7% of the identified viremic patients proceeded with treatment (n=509). So far, 390 patients with sustained virologic response (SVR) have been documented, representing 53% among the infected and 78% among those who underwent treatment. The remaining percentage of treated patients (n=119) encompasses mainly loss to follow-up cases underscoring the persistent challenges of documenting SVR. A 3% (n=20) of the successfully cured patients experienced reinfection. Regarding the adapted protocols, 37% of the established pathways required up to two clinical visits from test to treat only, while an even more efficient 46% of the pathways require no hospital visits, affirming the CAS's role as a one-stop-shop fostering a streamlined and PUD-friendly experience. 
Conclusion: This initiative underscores the importance of adaptability and comprehensive care models in healthcare systems, particularly in the context of HCV elimination among PUDs. The findings highlight the necessity for enhanced measures to ensure consistent documentation of SVR and suggest potential strategies like incentivizing treated individuals and intensifying screening efforts among more marginalized PUD groups. The success of the CAS as a one-stop-shop model offers valuable insights for similar healthcare initiatives globally.