Abstract
Background. People who inject drugs (PWID) and homeless people represent now a large reservoir of Hepatitis C virus (HCV) infection. However, Hepatis C elimination programs can barely reach these subgroups of patients. We aimed to evaluate and compare the retention in care among these difficult-to-treat patients when managed for HCV in hospital or in an out-of-hospital setting. Methods. In our retrospective study, we categorized the included patients (PWID and homeless persons) into two groups according to whether anti-HCV treatment was offered and provided in a hospital or an out-of-hospital setting. We run logistic regressions to evaluate factors associated with retention in care (defined as the completion of direct antiviral agents (DAAs) therapy). Results. We included 56 patients in our study: 27 were in the out-of-hospital group. Overall, 33 patients completed DAAs therapy. A higher rate of retention in care was observed in the out-of-hospital group rather than in-hospital group (p = 0.001). At the univariate analysis, retention in care was associated with the out-of-hospital management (p = 0.002) and with a shorter time between the first visit and the scheduled start of DAAs (p = 0.003). Conclusions. The choice of treatment models that can better adapt to difficult-to-treat populations, such as an out-of-hospital approach, will be important for achieving the eradication of HCV infection.
Highlights
Due to the difficulties in treating people who inject drugs (PWID), along with often asymptomatic course of Hepatitis C virus (HCV) infection, there is a risk of underestimating individuals affected by hepatitis C [1]
Our study showed how an out-of-hospital care model might guarantee a greater percentage of patients starting direct antiviral agents (DAAs) with an overall better retention in care for difficult-to-reach groups with HCV infection
The patients with diagnosis of chronic hepatitis C managed in the out-of-hospital setting were more likely to initiate and complete the therapy, achieving the primary outcome, in comparison to the individuals treated in hospital (p = 0.002)
Summary
Prevalence studies have reported that homeless persons are at high risk for HCV, mostly as a result of injection drug use [7]. Homelessness and unstable housing have been recently associated to a greater risk for acquiring infections such as HCV and human immunodeficiency virus (HIV) among PWID when compared to PWID who had stable house [8]. A large meta-analysis has estimated an overall prevalence of HCV infection ranged from 3.9% to 36.2% in homeless people, based on the results of 12 eligible studies [7]. Guidelines for hepatitis C treatment from both the American and the European Association for the Study of Liver Diseases recommends to treat PWID with chronic HCV infection [11,12]
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