Successful Implementation of Hepatitis C Virus Point-of-Care Testing in a Syringe Services Program

Abstract

Background:

Syringe services programs (SSPs) serve many people who use drugs (PWUD) who need treatment for hepatitis C virus (HCV). The need for laboratory-based HCV RNA testing can present a barrier to diagnosis, care, and treatment. We evaluated the receipt of HCV test results and initiation of the treatment evaluation process among PWUD who received a point-of-care (POC) HCV RNA testing in an SSP.

Methods:

We conducted an observational, prospective study of clients of a health department-run SSP in Seattle, Washington. Participants completed a one-step HCV testing algorithm using POC HCV RNA testing (Xpert^® HCV). Participants with HCV received referrals to onsite and offsite treatment providers; same-day treatment was not available at the time of study.

Results:

Two hundred participants enrolled and received testing. Most participants (74.5%) reported a history of injection drug use (IDU), and 28.5% reported IDU in the past 30 days. Thirty-one participants (15.5%) had a positive HCV RNA test result, 161 (80.5%) had a negative result, and 8 (4.0%) had no result. Nearly all participants (97.0%) received their test result. Six months after testing, among 31 participants with HCV, 8 (25.8%) had initiated the treatment process at the SSP by scheduling at least 1 appointment; 3 (9.7%) started HCV medications through the SSP. No additional participants achieved SVR4 from treatment at another local site at 6 months.

Conclusions:

We successfully implemented POC HCV RNA testing at an SSP with a high level of returned results. Despite the availability of onsite treatment, relatively few participants with HCV initiated the treatment evaluation process. Linkage to treatment may be improved with additional social supports and/or implementing a protocol with a streamlined initial evaluation and same-day treatment initiation.

Clinical Trials Registration:

One-step HCV RNA Testing Among SSP Participants (HOT Study). https://clinicaltrials.gov/study/NCT06634342.