Author: Seaman A, Witkowska M, Chan B, Nelson L, Korthuis T

Theme: Clinical Research Year: 2019

Background: To reach World Health Organization elimination targets, we must rapidly diagnose and
treat hepatitis C (HCV) in people who inject drugs (PWIDs). PWIDs are challenging to engage in HCV
treatment, due to homelessness or mistrust of traditional healthcare services. The need for multiple
provider appointments, high laboratory burden, and system fragmentation all complicate HCV care.
To achieve elimination and improve HCV care, we need streamlined care pathways and interventions
to treat hard-to-reach PWID populations.
Methods: We designed an integrated, multi-faceted opt-out HCV screening and linkage-to-care
program in a healthcare for the homeless services institution in Portland, Oregon. Our aim is 80%
HCV elimination by 2024 across 24 transitional housing entities, 2 primary health clinics, and
multiple addiction programs, and 80% screening and linkage-to-care in a medically supported
withdrawal center. Front-line staff initiate a 1-click universal screening and referral that triggers a
multi-reflex novel lab algorithm combining screening, confirmation, and pre-treatment lab workup in
a single blood draw. A clinician reviews labs and orders presumptive direct-acting antivirals and
insurance authorization is processed. The pharmacist or provider initiates appropriate treatment on
the first visit. In our respondent-driven sampling model, patients at housing sites are financially
incentivized to receive lab results after screening, and also to engage others to screen.
Results: We identified 10,002 patients eligible for HCV screening that predict 1,231 cases of active
HCV and 1,043 cases initiating treatment in the first 12 months. We hypothesize that the 1-click
streamlined screening and referral will save health resources, minimize follow-up loss, and improve
case finding among hard-to-reach PWID and transitional housing populations.
Conclusions: We developed a unique, streamlined, and integrated model of treating hard-to-reach
PWID populations for HCV that could inform broader HCV elimination efforts. If successful, we will
maintain ongoing screening and re-infection programs to rapidly respond to incident infections.
Disclosure of Interest Statement: Dr. Seaman has received grant funding for investigator-initiated
research from Merck & Co. and program development support from the Gilead FOCUS foundation.
All clinical work and data analysis and collection are his own.

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