A Feasibility Study to Increase Chronic Hepatitis C Virus RNA Testing and Linkage to Care Among Clients Attending Homeless Services in Amsterdam, The Netherlands

Author: Ellen Generaal

Theme: Models of Care Year: 2022

Background: People who inject drugs (PWID) are disproportionately affected by hepatitis C virus
(HCV) infections and are frequently homeless. To improve HCV case finding in these individuals, we
examined the feasibility of rapid HCV RNA testing in homeless services in Amsterdam.
Description of model of care/intervention: In 2020, we provided a comprehensive service to homeless
facilities, which included workshops on HCV for personnel, a “hepatitis ambassador” at each facility, a
rapid, onsite HCV RNA fingerstick test service, and assistance with linkage to care. Risk factors for HCV
RNA-positive status were examined using Bayesian logistic regression.
Effectiveness: Of the 152 participants enrolled, 150 (87% men; median age: 47 years) accepted rapid
HCV testing. Seven tested HCV RNA positive (4.7%, 95%CrI = 1.31-8.09; 7/150). Of these, five (71%)
were linked to care, of whom four (57%, 4/7) initiated treatment and one (14%, 1/7) delayed treatment
due to a drug-drug interaction. Of these four people, two completed treatment (50%), of whom one
(25%) achieved sustained virologic response after 12 weeks. HCV RNA-positive individuals were more
likely to originate from Eastern Europe (posterior-odds ratio (OR) = 3.59 (95% credible interval (CrI) =
1.27-10.04)) and to inject drugs (ever: posterior-OR = 3.89 (95% CrI = 1.37-11.09); recent: posteriorOR = 3.94 (95% CrI = 1.29-11.71)).
Conclusion and next steps: We identified HCV RNA-positive individuals and linkage to care was
relatively high. Screening in homeless services with rapid testing is feasible and could improve HCV
case finding for PWID who do not regularly attend primary care or other harm reduction services for
people who use drugs.
Disclosure of Interest: This project was funded by pharmaceutical companies, one of which provided the HCV tests and
testing device. We declare that these companies were not involved in the study preparation, data
collection, data analyses, data interpretation, or the writing of this manuscript.

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