P69 NEXIT: Needle exchange initiative targeting hepatitis C (HCV) incidence in people who inject drugs (PWID) – phase 1

Abstract

Background Injecting drug use accounts for ~90% of HCV infections in the UK. Needle and Syringe Programs (NSPs) present a key opportunity for early detection of incident HCV infection in active injectors. Despite this, there are no clear pathways for this vulnerable group. Our aim was to establish a defined blood-borne virus (BBV) testing pathway for people accessing NSPs co-located with drug treatment services (DTS) and streamline care for clients diagnosed with HCV. Description of Model of Care/Intervention We commissioned a behavioural science research group to conduct an observational study at three NSP sites to map pathways and identify barriers to BBV testing and linkage-to-care (LTC). These outputs informed our multidisciplinary steering committee, consisting of the HCV treatment delivery network, CGL (DTS provider), local NSP staff and Gilead. We agreed an optimised BBV pathway to integrate HCV clinical assessment and treatment into harm reduction within the NSP. We then launched a multifaceted campaign including bespoke training, data support, peer mentorship and disease awareness materials. Effectiveness Prior to this initiative, BBV testing was ad-hoc and data capture was not required. The project is currently ongoing; 6-month snapshot analysis (Feb2020): 732 unique clients attended NSP 100% (n=732) offered a BBV test 22% (162/732) accepted 41% (66/162) HCV antibody positive 20% (33/162) HCV PCR positive 75% (25/33) referred to the on–site hepatology clinic 24% (8/33) started and 6% (2/33) completed treatment Conclusion Integrated NSP-BBV pathways will be crucial to eliminate HCV given the high prevalence observed. Linkage to care is ongoing; however, to-date, we have successfully initiated therapy in 8 patients at risk of onward transmission. The early data suggest testing uptake in this group is challenging. Phase 2 is focusing on increasing uptake of BBV testing and increasing linkage to treatment within the NSP. Disclosure of Interest Statement The observational study, CGL coordinators and data analyst were funded by Gilead Sciences as part of the NHS England HCV Elimination Programme.