Theme: Models of Care Year: 2022
To reach the 2030 hepatitis C virus (HCV) elimination goal set by the World Health
Organization, a new model of care with simplified pathways catered to people who use drugs
(PWUD) attending addiction services centres (ASCs) on the Balearic Islands, Spain, has been
implemented since April 2021.
Description of model of care/intervention:
The model (Figure) has been implemented in 16 of 17 ASCs serving the islands and consists of
four phases: 1) recruitment and HCV screening onsite via anti-HCV antibody testing
(Oraquick®) and dried blood spot (DBS) testing to confirm viremia (HCV-RNA); 2) treatment
prescription via telemedicine and repackaging to facilitate its dispensing in the ASCs; 3) linkage
to specialist care through new communication channels between ASC professionals and
hospitals; and 4) sustained virological response (SVR) monitoring onsite via DBS at 4 and 12
weeks after treatment completion.
Of 626 patients, 234 (37%) were anti-HCV+ and 92 (15%) HCV-RNA+. Of those HCV-RNA+
(mean age 46.6 [SD: 8.83]) 65 (71%) were men, 79 (86%) were Spanish-born, 84 (91%)
reported a previous HCV diagnosis, 21 (23%) reported previous HCV treatment and 15 (16%)
had an HIV co-infection. Of those HCV-RNA+, 73 (79%) have started treatment, 19 (21%) are
pending its initiation and 52 (57%) have completed it. SVR4 and SVR12 monitoring tests were
performed in 33 (63%) and 19 (37%) patients who completed treatment, respectively; 91%
(n=30) and 95% (n=18) of the SVR4 and SVR12 monitoring tests showed undetectable HCVRNA, respectively. Five (1%) patients abandoned the project.
Conclusion and next steps:
Decentralising HCV diagnosis, prescription and treatment dispensing makes it easier for PWUD
attending ASCs to complete the HCV care cascade and achieve SVR. Strategies which simplify
the cascade for PWUD are effective in helping eliminate HCV in this key population. Next steps
include continuing participant recruitment, treatment and monitoring.
Disclosure of interest statement:
MB reports advisory fees from Gilead Sciences, Abbvie, GlaxoSmithKline and Assembly
Biosciences, and speaker fees from Gilead Sciences and Abbvie, outside of the submitted work.
JVL acknowledges a grant from Gilead Sciences to ISGlobal to fund this study, grants and
speaker fees from Gilead Sciences and MSD and speaker fees from AbbVie, Genfit, Intercept
and ViiV, outside the submitted work. AH, MV, MP, MM, JMA, TM, AA, BR, NDC, AO, MR, ML,
NS, JS, SV, EG, RE, IC, VM, CAP and ÀV have nothing to disclose.