A Feasibility Study to Increase Chronic Hepatitis C Virus RNA Testing and Linkage to Care among Clients Attending Homeless Services in Amsterdam, The Netherlands.

Anders Boyd,Hilje Logtenberg van der Grient,Ellen Generaal,Maria Prins,Daniela K. van Santen,Bert L. C. Baak,Eberhard Schatz,Sara K. Woods

doi:10.3390/diagnostics11071197

Abstract

People who inject drugs (PWID) are disproportionately affected by hepatitis C virus (HCV) infections and are frequently homeless. To improve HCV case finding in these individuals, we examined the feasibility of rapid HCV RNA testing in homeless services in Amsterdam. In 2020, we provided a comprehensive service to homeless facilities, which included workshops on HCV for personnel, a “hepatitis ambassador” at each facility, a rapid, onsite HCV RNA fingerstick test service, and assistance with linkage to care. Risk factors for HCV RNA-positive status were examined using Bayesian logistic regression. Of the 152 participants enrolled, 150 (87% men; median age: 47 years) accepted rapid HCV testing. Seven tested HCV RNA positive (4.7%, 95%CrI = 1.31–8.09; 7/150). Of these, five (71%) were linked to care, of whom four (57%, 4/7) initiated treatment and one (14%, 1/7) delayed treatment due to a drug–drug interaction. Of these four people, two completed treatment (50%), of whom one (25%) achieved sustained virologic response after 12 weeks. HCV RNA-positive individuals were more likely to originate from Eastern Europe (posterior-odds ratio (OR) = 3.59 (95% credible interval (CrI) = 1.27–10.04)) and to inject drugs (ever: posterior-OR = 3.89 (95% CrI = 1.37–11.09); recent: posterior-OR = 3.94 (95% CrI = 1.29–11.71)). We identified HCV RNA-positive individuals and linkage to care was relatively high. Screening in homeless services with rapid testing is feasible and could improve HCV case finding for PWID who do not regularly attend primary care or other harm reduction services for people who use drugs.

Highlights

Hepatitis C virus (HCV) is a major cause of liver cirrhosis and hepatocellular carcinoma [1]
CrI, credible interval; HCV, hepatitis C virus; OR, odds ratio; IQR, interquartile range. This cross-sectional study examined the feasibility of a rapid, onsite HCV RNA screening test and the resulting linkage to care for 150 clients of eight homeless services in Amsterdam, the Netherlands
We found a higher proportion of chronic hepatitis C (HCV RNA positive) infection among participants, at 4.7%, than is expected for the general population in the Netherlands (0.16%; [8])

Summary

Introduction

Hepatitis C virus (HCV) is a major cause of liver cirrhosis and hepatocellular carcinoma [1]. An estimated 50–80% of adults with acute HCV infection develop chronic infection. Of the people chronically infected with HCV, 12–30% develop liver cirrhosis within 20 years if left untreated [2]. As part of the HCV elimination goals established by the World Health Organization (WHO), 90% of all individuals infected with HCV should be diagnosed by 2030 [3]. In 2015, only 20% of HCV-infected people were estimated to be diagnosed worldwide [4]. A study in 2012 from the southern region of the Netherlands indicated that 66% of HCV infections were ‘hidden’ to current screening practices [5]. Coverage of HCV diagnoses may have improved with recent HCV screening programs, such as increased case finding among PWID [6,7]

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