Two-thirds of new hepatitis C virus (HCV) infections occur in people who inject drugs (PWID). Despite high rates of HCV cure among PWID, treatment initiation remains low due to restrictive policies, stigma, and inflexible care in traditional healthcare settings. This single-site, randomized controlled trial evaluated the effect of an HCV treatment model co-located at a syringe service program (SSP)—including flexible appointments, drop-ins, and proactive outreach for missed visits—compared with facilitated referral by an on-site coordinator to off-site HCV care. The outcome was the probability of HCV cure (sustained virologic response) 12 months after study enrollment.
- Patients receiving HCV care at an SSP had a higher probability of HCV cure (55 of 82 patients; 67%), compared with those receiving off-site HCV care (19 of 83 patients; 23%).
- Differences in HCV cure probabilities were driven by higher rates of referral to and attendance at HCV clinician visits (attendance among those referred: 87% co-located care versus 37% off-site care). Among those in both groups who initiated medication, the probabilities of cure were similar (~85%).
Comments: Co-located HCV care in an SSP resulted in a probability of cure that was 3 times higher than a facilitated referral to off-site care model, largely driven by increased treatment initiation. Notably, many study participants were successful in the co-located program despite not being direct clients of the SSP, suggesting that providing care in a de-stigmatized harm reduction setting provides a substantial engagement advantage over traditional medical care settings.
Paul J. Christine, MD, PhD* & Alexander Y. Walley, MD, MSc
* Contributing editorial intern and Addiction Medicine Fellow, Boston Medical Center
Reference: Eckhardt B, Mateu-Gelabert P, Aponte-Melendez Y, et al. Accessible hepatitis C care for people who inject drugs: a randomized clinical trial. JAMA Intern Med. 2022;182(5):494–502.