A Testing Campaign Intervention Consisting of Peer-Facilitated Engagement, Point-of-Care HCV RNA Testing, and Linkage to Nursing Support to Enhance Hepatitis C Treatment Uptake among People Who Inject Drugs: The ETHOS Engage Study

Anna Conway; Heather Valerio; Maryam Alavi; David Silk; Carla Treloar; Behzad Hajarizadeh; Alison D Marshall; Marianne Martinello; Andrew Milat; Adrian Dunlop; Carolyn Murray; Bianca Prain; Charles Henderson; Janaki Amin; Phillip Read; Pip Marks; Louisa Degenhardt; Jeremy Hayllar; David Reid; Carla Gorton; Thao Lam; Michael Christmass; Alexandra Wade; Mark Montebello; Gregory J Dore; Jason Grebely; ETHOS Engage Study Group

doi:10.3390/v14071555

A Testing Campaign Intervention Consisting of Peer-Facilitated Engagement, Point-of-Care HCV RNA Testing, and Linkage to Nursing Support to Enhance Hepatitis C Treatment Uptake among People Who Inject Drugs: The ETHOS Engage Study

Viruses. 2022 Jul 16;14(7):1555. doi: 10.3390/v14071555.

Authors

Anna Conway^{1

2}, Heather Valerio¹, Maryam Alavi¹, David Silk¹, Carla Treloar², Behzad Hajarizadeh¹, Alison D Marshall^{1

2}, Marianne Martinello¹, Andrew Milat³, Adrian Dunlop^{4

5}, Carolyn Murray⁶, Bianca Prain⁶, Charles Henderson⁷, Janaki Amin⁸, Phillip Read⁹, Pip Marks¹, Louisa Degenhardt¹⁰, Jeremy Hayllar¹¹, David Reid¹², Carla Gorton¹³, Thao Lam¹⁴, Michael Christmass^{15

16}, Alexandra Wade^{17

18}, Mark Montebello¹⁹, Gregory J Dore¹, Jason Grebely¹; ETHOS Engage Study Group

Affiliations

¹ The Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia.
² Centre for Social Research in Health, UNSW Sydney, Sydney, NSW 2052, Australia.
³ Centre for Epidemiology and Evidence, NSW Health, Sydney, NSW 2065, Australia.
⁴ Hepatitis NSW, Surry Hills, NSW 2010, Australia.
⁵ Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW 2300, Australia.
⁶ Population Health Strategy & Performance, NSW Health, Sydney, NSW 2065, Australia.
⁷ NSW Users and AIDS Association, Surry Hills, NSW 2010, Australia.
⁸ Department of Health Systems and Populations, Macquarie University, Sydney, NSW 2109, Australia.
⁹ Kirketon Road Centre, Sydney, NSW 2010, Australia.
¹⁰ National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW 2052, Australia.
¹¹ Alcohol and Drug Service, Metro North Mental Health, Metro North Hospital and Health Service, Brisbane, QLD 4029, Australia.
¹² Drug and Alcohol Service, Illawarra Shoalhaven Local Health District, Wollongong, NSW 2500, Australia.
¹³ Cairns Sexual Health Service, Cairns, QLD 4870, Australia.
¹⁴ Drug Health, Western Sydney Local Health District, Sydney, NSW 2145, Australia.
¹⁵ Next Step Community Alcohol and Drug Service, Perth, WA 6004, Australia.
¹⁶ National Drug Research Institute, Curtin University, Perth, WA 6102, Australia.
¹⁷ Mid North Coast Liver Clinic, Mid North Coast Local Health District, Coffs Harbour, NSW 2450, Australia.
¹⁸ Drug and Alcohol Services, Mid North Coast Local Health District, Coffs Harbour, NSW 2450, Australia.
¹⁹ North Sydney Local Health District, Sydney, NSW 2077, Australia.

Abstract

This study evaluated HCV treatment initiation among people who inject drugs (PWID) following an intervention of campaign days involving peer connection, point-of-care HCV RNA testing, and linkage to nursing support. ETHOS Engage is an observational cohort study of PWID attending 25 drug treatment clinics and needle and syringe programs in Australia (May 2018-September 2019). Point-of-care results were provided to the nurse, facilitating confirmatory testing and treatment. The study aimed to evaluate treatment uptake and factors associated with treatment at 24 months post-enrolment. There were 317 people with current HCV infection and eligible for treatment (median age 43, 65% male, 15% homeless, 69% receiving opioid agonist treatment, 70% injected in last month). Overall, 15% (47/317), 27% (85/317), 38% (120/317), and 49% (155/317) of people with current HCV infection had initiated treatment at 3-, 6-, 12-, and 24-months following testing, respectively. Homelessness (adjusted hazard ratio (aHR): 0.40; 95% confidence interval: 0.23, 0.71) and incarceration in the past 12 months (vs. never, aHR:0.46; 0.28, 0.76) were associated with decreased treatment initiation in the 24 months post-enrolment. This testing campaign intervention facilitated HCV treatment uptake among PWID. Further interventions are needed to achieve HCV elimination among people experiencing homelessness or incarceration.

Keywords: Hepatitis C virus elimination; Hepatitis C virus infection; Hepatitis C virus treatment; direct-acting antiviral era; people who inject drugs.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Antiviral Agents / therapeutic use
Drug Users*
Female
Hepacivirus / genetics
Hepatitis C* / diagnosis
Hepatitis C* / drug therapy
Hepatitis C* / epidemiology
Humans
Male
Point-of-Care Systems
RNA
Substance Abuse, Intravenous* / complications

Substances

Antiviral Agents
RNA

Grants and funding

The ETHOS Engage study is funded by a National Health and Medical Research Council (NHMRC) Partnership project grant (grant number 1103165), including funding from New South Wales Health and Cepheid. This study was also supported in part by a research grant from Investigator-Initiated Studies Program of Merck, Sharp and Dohme Corporation. The Kirby Institute is funded by the Australian Government Department of Health and Ageing. L.D. is supported by a US National Institute of Health (NIH), National Institute on Drug Abuse (NIDA) grant (R01DA1104470). G.J.D. is supported by a National Health and Medical Research Council (NHMRC) Investigator Grant (2008276). J.G. is supported by an NHMRC Investigator Grant (1176131). The contents of the published material are solely the responsibility of the individual authors and do not reflect the views of NHMRC.