Abstract
Background
Towards hepatitis C elimination among people who inject drugs (PWID), we assessed the effectiveness of a strategy consisting of a community-based respondent-driven sampling (RDS) as wide screening, a simplified and integrated hospital-based care, and prevention of reinfection supported by community-based organisations (CBO), in Hai Phong, Vietnam.
Methods
Adults who injected heroin were enrolled in a RDS survey implemented in two CBO premises. Rapid HIV and HCV tests were done on site, and blood was taken for HCV RNA testing. Those with detectable HCV RNA were referred with CBO support to three public hospitals for 12-week sofosbuvir/daclatasvir, plus ribavirin for patients with cirrhosis. Participants were followed-up 12 weeks post-treatment (SVR12) and 48 weeks after enrolment. The primary endpoint was the rate of undetectable HCV RNA participants at 48 weeks.
Findings
Among the 1,444 RDS survey participants, 875 had hepatitis C. Their median age was 41 years (IQR 36-47), 96% were males, 36% were HIV-coinfected. Overall, 686 (78·4%) started sofosbuvir/daclatasvirs, and 629 of the 647 (97·2%) patients tested at SVR12 were cured. At week 48, (581/608) 95·6% had undetectable HCV RNA, representing 66.4% of all PWID identified with hepatitis C. The reinfection rate after SVR12 was 4/100 person-years (95%CI: 2-7).
Interpretation
Our strategy, involving CBO and addressing all steps from wide HCV screening to prevention of reinfection, stands as a promising approach to eliminate HCV among PWID in low and middle-income countries.
Funding: France ANRS|MIE (#ANRS12380). The RDS survey was implemented with grants from the NIDA (#R01DA041978) and ANRS|MIE (#ANRS12353).
Keywords: hepatitis C, people who inject drugs, respondent-driven sampling, community-based organisations
Towards hepatitis C elimination among people who inject drugs (PWID), we assessed the effectiveness of a strategy consisting of a community-based respondent-driven sampling (RDS) as wide screening, a simplified and integrated hospital-based care, and prevention of reinfection supported by community-based organisations (CBO), in Hai Phong, Vietnam.
Methods
Adults who injected heroin were enrolled in a RDS survey implemented in two CBO premises. Rapid HIV and HCV tests were done on site, and blood was taken for HCV RNA testing. Those with detectable HCV RNA were referred with CBO support to three public hospitals for 12-week sofosbuvir/daclatasvir, plus ribavirin for patients with cirrhosis. Participants were followed-up 12 weeks post-treatment (SVR12) and 48 weeks after enrolment. The primary endpoint was the rate of undetectable HCV RNA participants at 48 weeks.
Findings
Among the 1,444 RDS survey participants, 875 had hepatitis C. Their median age was 41 years (IQR 36-47), 96% were males, 36% were HIV-coinfected. Overall, 686 (78·4%) started sofosbuvir/daclatasvirs, and 629 of the 647 (97·2%) patients tested at SVR12 were cured. At week 48, (581/608) 95·6% had undetectable HCV RNA, representing 66.4% of all PWID identified with hepatitis C. The reinfection rate after SVR12 was 4/100 person-years (95%CI: 2-7).
Interpretation
Our strategy, involving CBO and addressing all steps from wide HCV screening to prevention of reinfection, stands as a promising approach to eliminate HCV among PWID in low and middle-income countries.
Funding: France ANRS|MIE (#ANRS12380). The RDS survey was implemented with grants from the NIDA (#R01DA041978) and ANRS|MIE (#ANRS12353).
Keywords: hepatitis C, people who inject drugs, respondent-driven sampling, community-based organisations
| Original language | English |
|---|---|
| Article number | 100801 |
| Journal | The Lancet Regional Health - Western Pacific |
| Volume | 37 |
| Early online date | 26 May 2023 |
| DOIs | |
| Publication status | E-pub ahead of print - 26 May 2023 |
Bibliographical note
Funding Information:France ANRS|MIE (#ANRS12380). The RDS survey was implemented with grants from the NIDA (#R01DA041978) and ANRS|MIE (#ANRS12353).
Funding Information:
We thank all study participants. We also warmly thank the members of the community-based organizations for their engagement during all the study duration; the members of the data and safety monitoring board; the members of the scientific advisory board; all our colleagues from Thuy Nguyen, Kien An, and Viet Tiep hospitals, from Hai Phong University of Medicine and Pharmacy, and from SCDI, for their impressive commitment into this study. We also thank the National Agency for Research on AIDS, viral hepatitis and emerging infectious diseases (ANRS|MIE) and the US National Institute on Drug Abuse (NIDA) for their financial support, and the Hai Phong authorities for their constant support.
Publisher Copyright:
© 2023 The Author(s)
