Hepatitis C virus point-of-care microelimination approach in a vulnerable population in the South of Spain

José María Pinazo-Bandera; Jesús Aranda; Alberto Manuel García-García; Ramiro Alcántara; Aida Ortega-Alonso; Enrique Del Campo-Herrera; Encarnación Clavijo; M Dolores García-Escaño; Juan Jesús Ruiz Ruiz; Mónica Morales-Herrera; Vanesa Valle-López; Rosa Martín-Alarcón; Isabel Viciana; Juan Bautista Jiménez; Felix Fernández-García; Juan Pedro Toro-Ortiz; Elena Sánchez-Yáñez; Ismael Álvarez-Álvarez; Raúl J Andrade; Mercedes Robles-Díaz; Miren García-Cortés

doi:10.1093/gastro/goad077

Hepatitis C virus point-of-care microelimination approach in a vulnerable population in the South of Spain

Gastroenterol Rep (Oxf). 2024 Jan 22:12:goad077. doi: 10.1093/gastro/goad077. eCollection 2024.

Authors

José María Pinazo-Bandera^{1

2}, Jesús Aranda¹, Alberto Manuel García-García¹, Ramiro Alcántara¹, Aida Ortega-Alonso^{1

2}, Enrique Del Campo-Herrera¹, Encarnación Clavijo³, M Dolores García-Escaño¹, Juan Jesús Ruiz Ruiz⁴, Mónica Morales-Herrera⁵, Vanesa Valle-López⁵, Rosa Martín-Alarcón⁶, Isabel Viciana³, Juan Bautista Jiménez⁴, Felix Fernández-García¹, Juan Pedro Toro-Ortiz¹, Elena Sánchez-Yáñez⁷, Ismael Álvarez-Álvarez^{1

2}, Raúl J Andrade^{1

2}, Mercedes Robles-Díaz^{1

2}, Miren García-Cortés^{1

2}

Affiliations

¹ Gastroenterology Department, Málaga Biomedicine Research Institute-IBIMA BIONAND Platform, Virgen de la Victoria University Hospital, University of Málaga, Málaga, Spain.
² Biomedic Research Network in Hepatic and Digestive Diseases (CIBERehd), Madrid, Spain.
³ Microbiology Department, Málaga Biomedicine Research Institute-IBIMA BIONAND Platform, Virgen de la Victoria University Hospital, University of Málaga, Málaga, Spain.
⁴ Provincial Center for Drug Addiction, Provincial Council of Málaga, Málaga, Spain.
⁵ Meeting and Reception Center, (CEA-Cruz Roja), Málaga, Spain.
⁶ Municipal Reception Center, Málaga, Spain.
⁷ Farmacy Department, Virgen de la Victoria University Hospital, Málaga, Spain.

Abstract

Background: Since the introduction of direct-acting antivirals, thousands of chronic hepatitis C patients have been successfully treated. However, vulnerable populations have a higher prevalence of hepatitis C virus (HCV) infection and face barriers that impede their access to antivirals. We carried out an HCV microelimination program focused on vulnerable population groups in Malaga.

Methods: People in drug addiction treatment centers and homeless shelters in Malaga who participated in the program between October 2020 and October 2021 were included. After providing participants with educational information on HCV, a dry drop test (DDT) was used to collect blood for subsequent screening for HCV infection. The participants who were diagnosed with HCV infection were scheduled for comprehensive healthcare assessments, including blood tests, ultrasonography, elastography, and the prescription of antivirals, all conducted in a single hospital visit. Sustained viral response (SVR) was analysed 12 weeks after end of treatment.

Results: Of the 417 persons invited to participate, 271 (65%) agreed to participate in the program. These participants were screened for HCV infection and 28 of them were diagnosed with HCV infection (10%). These hepatitis C-infected patients had a mean age of 53 ± 9 years; 86% were males and 93% were or had been drug users. Among 23 patients with HCV infection, HCV genotype 1a predominated (74%). Medical exams showed that 19% (4/21) had advanced fibrosis (F3-4), and 5% (1/21) had portal hypertension. Finally, 23 infected patients received treatment with glecaprevir/pibrentasvir or sofosbuvir/velpatasvir and SVR was confirmed in 22 patients (96%).

Conclusions: Drug users and homeless people have a higher prevalence of HCV infection than the general population. The microelimination program with educational activity and screening tools achieved a high participation rate, easy healthcare access, and a high rate of SVR despite the SARS-CoV-2 pandemic.

Keywords: drug users; hepatitis C microelimination; vulnerable population.