ITTREAT (Integrated Community Test - Stage - TREAT) Hepatitis C service for people who use drugs: Real-world outcomes

Abstract

Background/aims: Direct-acting antivirals (DAAs) provide an unprecedented opportunity for a “find-and-treat strategy.” We aimed to report real-world clinical, patient reported and health economic outcomes of community-based hepatitis C virus (HCV) screening/treatment in people who use drugs (PWUDs). Methods: Project ITTREAT (2013-2021), established at a drug and alcohol treatment centre, offered a comprehensive service. Generic (SF-12v2 and EQ-5D-5L) and liver-specific (SFLDQoL) health-related quality of life (HRQoL) were assessed before and after HCV treatment. Costs/case detected and cured were calculated. Primary outcome measure was sustained virological response (SVR) (intention to treat). Results: Till March 2018, 573 individuals recruited, 462 (81%) males, mean age 40.5 ± 10.0 years. Of the 125 treated, 115 (92%) had past/current history of injecting drug use, 88 (70%) were receiving opioid agonist treatment and 50 (40%) were homeless. Twenty-six per cent received interferon-based and 74% DAA-only regimens. SVR (ITT) was 87% (90% with DAAs). Service uptake/HCV treatment completion rates were '95%, HCV reinfection being 2.63/100 person years (95% CI 0.67-10.33). HRQoL improved significantly at end of treatment (EOT) in those with SVR: SFLDQoL (symptoms, memory, distress, loneliness, hopelessness, sleep and stigma) (P'/ =.011); SF-12 v2 physical and mental health domains (P '.001); and EQ-5D-5L composite profile score (P =.009) and visual analogue scale, P '.001. Cost (British pounds 2018) per case detected was £171; mean cost per cure (excluding medication) was £702 ± 188. Conclusions: Excellent real-world SVRs in PWUDs with significant improvement in HRQoL can be achieved at modest costs. Project ITTREAT endorses community-based integrated services to help achieve HCV elimination.