Rapid hep C point-of-care RNA testing and treatment at an integrated supervised consumption service in Toronto, Canada

Author: Bernadette Lettner

Theme: Models of Care Year: 2021

Background: Recent expansion of supervised consumption services (SCS) offers new opportunities to engage people who inject drugs (PWID) in Hepatitis C virus (HCV) care. We aim to evaluate the feasibility of rapid, point-of-care (POC) RNA testing and linkage to care among service users of a small-scale SCS co-located within a primary care community health centre. Description of model of care/intervention: Participants were enrolled from August 2018 to June 2019. SCS accommodates an average of 35 visits/day and testing was conducted 3 days/week. Participants with negative results offered repeat testing every 3 months for 1 year. HCV RNA positive (+) participants who initiated further assessments with the on-site HCV nurse were defined as linked to care. Follow-up for HCV RNA+ participants is on-going. We examined the proportion of prior HCV testing, POC testing results and subsequent linkage to care for HCV RNA+ participants at baseline. Effectiveness: Among 125 participants (mean age 40.8±11.4 years, 66.1% male, 67.2% white) 73.6% reported unstable/no housing and 68% reported daily injection drug use. Among those who reported prior HCV testing (69.6%), 64.4% stated they knew their current HCV status. There were 118 valid POC test results at baseline and all participants received their test results. Among HCV RNA+ participants (41.5%), 34.7% were newly identified and 53.1% were linked to HCV care. Among those linked to care, 46.2% initiated treatment at this site and all have completed treatment to-date. No participants on treatment at the program site have been lost to follow-up and all those who completed the 12-week post-treatment follow-up have achieved sustained virologic response. Conclusion and next steps: Proportion of newly identified HCV RNA+ remains high among this highrisk group, however engagement was also high at this site. POC HCV RNA testing within SCS with ongoing access to care for HCV RNA+ participants is a promising model to increase HCV engagement among PWIDs. Disclosure of Interest Statement: This study is supported by a grant from Gilead Sciences and by inkind support from Cepheid. Figure 1: 69 HCV RNA negative participants Point-of-care HCV RNA valid test results at baseline (N = 118 [94.4%]) HCV RNA+ participants (N = 49 [41.5%]) HCV RNA+ participants linked to care (N = 26 [53.1%]) Participants who initiated treatment (N = 12 [46.2%]) Participants who completed treatment (N = 12 [100%]) 23 HCV RNA+ participants missed their initial intake appointment with the HCV nurse 3 died prior to initiating/early treatment 2 in jail 1 acute clearance 1 waiting for chronicity 1 being treated elsewhere 6 lost to follow-up

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