Theme: Models of Care Year: 2024
Background: Nai Zindagi Trust (NZT) operates a harm reduction program in Pakistan with daily access to 6500-7000 people who inject drugs (PWID), offering HIV prevention, testing, and linkage to antiretroviral treatment. High prevalence of HIV/HCV co-infection, the risk of liver disease, treatment complications and expected high mortality call for urgent attention for HCV treatment. However, barriers such as fragmentation in health system, absence of case management, limited resources for diagnostic, socio-ecological barriers, chaotic drug use, and stigma impede the uptake of HCV treatment among PWID.
Description: Utilizing its extensive outreach program, NZT seized a missed opportunity by integrating HCV treatment linkages in collaboration with a private service provider network across 11 high burden districts spanning three provinces. This collaboration between NZT and the service provider network effectively addressed the treatment needs of HCV-positive PWID and their spouses, besides ensuring responsiveness, quality of care, and robust reporting. The HCV care services include rapid testing, treatment diagnostics, counselling, clinical consultations, medication regimen, and post-treatment PCR testing.
Effectiveness: Since the commencement of services from July, 2023, a total of 783 beneficiaries have been referred to date, comprising 752 male PWID and 31 female spouses. Almost 70% of the beneficiaries belong to age between 20-39 years. Results indicate that 591 of the referred cases tested positive for Hep-C on PCR, of which 94% (556) received HCV treatment. By the 7th March 2024, 44 of the 48 eligible cases were negative on post treatment PCR exhibiting treatment success.
Conclusion and next steps:
This innovative model demonstrates effectiveness in HCV treatment linkages by ensuring improved uptake, retention, and 91% cure of HCV infection, directly impacting both individual and public health outcomes. The success of this intervention has led scale up plan to cover all 58 districts where harm reduction services are currently being implemented by NZT.