Theme: Models of Care Year: 2019
Background:
Improving hepatitis C virus (HCV) treatment uptake and outcomes among people who inject drugs
(PWID) is crucial to achieve the WHO elimination goals. The aim of this study was to describe the
cascade of care, treatment outcomes and reinfection rates in an urban cohort of PWID attending a
low-threshold HCV clinic.
Description of model of care/intervention:
The clinic was established in 2013 within the premises of Oslo´s harm reduction services and is
staffed by a general practitioner and two nurses with specialist support. The nurses draw blood,
operate a portable transient elastography and provide individually tailored HCV treatment with
emphasis on flexibility and ambulant work.
Effectiveness:
By March 2019 the clinic had tested 617 individuals, of whom 403 (65%) had chronic HCV infection.
329 of 403 (82%) were subsequently assessed with elastography (16% had LS>12.5 kPa) and 261 of
those (79%) had initiated treatment. Cumulative treatment uptake among viremic individuals was
65% (261 of 403). Among 142 untreated individuals, 68 were retained in care, 67 were lost to followup and 7 had died. Among 129 individuals due for SVR4 assessment by March 2019, mean age was
48 years, 76% were male and 26% had LS>12.5 kPa. Injecting drug use during treatment was
reported by 81% and 79% received OST. In intention to treat analysis, SVR4 was observed in 99 of
129 (77%), two had virological failure, five discontinued treatment and 23 were lost to follow-up. In
observed analysis, excluding discontinuations and loss to follow-up, 99 of 101 (98%) achieved SVR4.
Four cases of possible reinfection (incidence 4.2/100 PY; 95% CI 1.1-10.7), of which three cases were
probable cases (incidence 3.1/100 PY; 95% CI 0.64-9.1), were observed over 96 PYFU.
Conclusion and next steps:
Demonstrating promising treatment uptake and high virologic response, this study provides real-life
data on the feasibility of a model of care that could be disseminated to other urban areas.
Disclosure of Interest Statement:
HM and OD: consultant/advisor and lecture fees from Abbvie, Gilead and MSD
The clinic uses a mobile transient elastography device donated from Abbvie