Z Gastroenterol 2020; 58(05): e98-e99
DOI: 10.1055/s-0040-1712310
Hepatologie

Achieving hepatitis C elimination in people who inject drugs - interim results of an innovative screen-and-treat program in Austria

C Schmidbauer
1   Wilhelminenspital, 4. Med. Abteilung, Wien, Austria
2   Medizinische Universität Wien, Universitätsklinik für Innere Medizin III, Klinische Abteilung für Gastroenterologie und Hepatologie, Wien, Austria
3   Vienna HIV & Liver Study Group, Wien, Austria
,
R Schubert
4   Suchthilfe Wien gGmbH, Ambulatorium Suchthilfe Wien, Wien, Austria
,
A Schütz
4   Suchthilfe Wien gGmbH, Ambulatorium Suchthilfe Wien, Wien, Austria
,
C Schwanke
4   Suchthilfe Wien gGmbH, Ambulatorium Suchthilfe Wien, Wien, Austria
,
E Gutic
1   Wilhelminenspital, 4. Med. Abteilung, Wien, Austria
,
M Schwarz
1   Wilhelminenspital, 4. Med. Abteilung, Wien, Austria
2   Medizinische Universität Wien, Universitätsklinik für Innere Medizin III, Klinische Abteilung für Gastroenterologie und Hepatologie, Wien, Austria
3   Vienna HIV & Liver Study Group, Wien, Austria
,
R Pirker
1   Wilhelminenspital, 4. Med. Abteilung, Wien, Austria
,
T Lang
1   Wilhelminenspital, 4. Med. Abteilung, Wien, Austria
,
T Reiberger
2   Medizinische Universität Wien, Universitätsklinik für Innere Medizin III, Klinische Abteilung für Gastroenterologie und Hepatologie, Wien, Austria
3   Vienna HIV & Liver Study Group, Wien, Austria
,
H Haltmayer
4   Suchthilfe Wien gGmbH, Ambulatorium Suchthilfe Wien, Wien, Austria
,
M Gschwantler
1   Wilhelminenspital, 4. Med. Abteilung, Wien, Austria
5   Sigmund Freud Universität, Wien, Austria
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Background People who inject drugs(PWIDs) represent a high-prevalence population for HCV infection. We aimed to eliminate HCV in this population by a combined screen-and-treat strategy.

Methods Study part 1: HCV-infected PWIDs are often reluctant to attend tertiary care centers providing HCV therapy. Next to poor adherence, they are unlikely to maintain a regular drug intake if provided with DAAs for self-administration. Therefore, HCV treatment was performed as “directly observed therapy”(DOT) since 2014: Patients received DAA together with OST under direct supervision of medical staff at a pharmacy or low-threshold facility.Study part 2: In Vienna, long-term OST-prescriptions have to be renewed monthly at one of nine awarding authority centers – rendering these institutions as ideal interfaces for HCV screening. We offer all PWIDs saliva-based testing for anti-HCV antibodies (OraQuick®) - followed by HCV-RNA PCR in case of a positive anti-HCV result. HCV-RNA(+) PWIDs are referred to a low-threshold facility for initiation of DAA therapy.

Results Study part 1: Using the concept of DOT, only 0.3 % of scheduled dates for DAA intake were missed by n = 409 patients. 289 of 290(99.7 %) PWIDs who finished treatment and 12 weeks of follow-up achieved SVR12; one patient with genotype 3 HCV infection showed nonresponse. Reinfection occurred in 18/289(6.2 %) patients. 89/409(21.8 %) patients are still on treatment and n = 30/409(7.3 %) were lost to follow-up.Study part 2: Screening at awarding authority centers was well accepted by PWIDs. So far, 2810 patients were included: 34.6 % already knew about their HCV-status and were sent to the low-threshold facility for further evaluation and treatment. Of the tested population 46.5 % showed anti-HCV(+) and 34.4 % were viremic.

Conclusion DOT is highly effective in PWIDs on OST with a high risk of non-adherence to DAA therapy. HCV-screening of PWIDs at public institutions is well accepted and may identify a considerable number of unknown HCV cases.



Publication History

Article published online:
26 May 2020

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