Accessible HCV Care For People Who Inject Drugs: Randomized Clinical Trial Comparing Low-Threshold Treatment at a Syringe Service Program Versus Facilitated Referral.

Author: Benjamin Eckhardt Yesenia Aponte-Melendez Chunki Fong Shashi Kapadia Melinda Pai Pedro Mateu-Gelabert Kristen Marks

Theme: Clinical Research Year: 2022

To achieve hepatitis C virus (HCV) elimination, treatment programs need to be developed to engage,
treat, and cure people who inject drugs (PWID).

We present final data from the Accessible Care Trial for curing HCV in PWID. The randomized clinical
trial compared on-site, low-threshold HCV treatment with care-coordination at a NYC syringe service
program (Accessible Care) with facilitated referral to local providers through a patient navigation
program (Usual Care). Eligible participants were HCV RNA+ and had injected drugs in the past 90 days.
The primary endpoint was achievement of sustained virologic response (SVR12) within 12 months of

Among the 572 participants screened, 167 met eligibility criteria and were enrolled, with two excluded
post-randomization (N=165). Demographics were similar with a median age of 41 years; 22% women.
At baseline, 84% of participants had injected drugs in the past 30 days with those averaging 22
injections/month, 70% were receiving either methadone or buprenorphine, 57% were recently
homeless, 7% were HIV+, and 11% were HCV treatment experienced. In the intention-to-treat analysis,
55/82 (67.1%) of the Accessible Care arm and 19/83 (22.9%) of the Usual Care arm achieved SVR12
(p<0.001). The SVR12 rates of those starting therapy were 55/64 (85.9%) and 19/22 (86.3%) in the two
arms (p=0.96). Loss to follow-up (12.2% and 16.9%, p=0.51) was similar in the two arms. Significantly
more participants in the Accessible Care arm achieved all steps in the care cascade with the greatest
attrition in the Usual Care arm seen in referral to clinician and attending clinical visit.

Among HCV RNA+ PWID significantly higher rates of cure were achieved using the Accessible Care model
focused on low-threshold, destigmatized, flexible HCV care compared to facilitated referral. To achieve
HCV elimination, expansion of treatment programs specifically geared toward engaging PWID is

Disclosure of Interest Statement:
Benjamin Eckhardt, Kristen Marks, and Shashi Kapadia receive research grant support from Gilead
Sciences for studies not related to this abstract.

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