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. 2021 Apr:90:103057.
doi: 10.1016/j.drugpo.2020.103057. Epub 2020 Dec 11.

The hepatitis C care cascade among people who inject drugs accessing harm reduction services in Catalonia: Major gaps for migrants

Cinta Folch  1 , Verónica Saludes  2 , Juliana Reyes-Ureña  1 , Adrián Antuori  3 , Nuria Ibáñez  4 , Xavier Majó  4 , Joan Colom  4 , Lurdes Matas  2 , Jordi Casabona  1 , Elisa Martró  5 ; HepCdetect II Study Group
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The hepatitis C care cascade among people who inject drugs accessing harm reduction services in Catalonia: Major gaps for migrants

Cinta Folch et al. Int J Drug Policy. 2021 Apr.

Abstract

Background: This study aimed to describe the HCV cascade of care among people who inject drugs (PWID) in Catalonia, as well as to compare the observed gaps in care between Spanish-born and migrant PWID.

Methods: A cross-sectional study of PWID (N = 410) attending four harm reduction services (HRS) was performed in 2016-17 (HepCdetect II Study). Participants were tested for both HCV antibodies (rapid testing) and RNA (from dried blood spot samples). The HCV care cascade was estimated from HCV testing results combined with self-reported data on previous testing, diagnosis and treatment collected through a questionnaire. Logistic regressions were used to test for an association between migration status and the proportions observed in each step of the HCV care cascade adjusting for age, sex, years of injection, homelessness, and treatment for drug dependence.

Results: Overall, 85.4% were men and 28.0% were migrants. Among Spanish-born (n = 295) and migrant (n = 115) PWID participants in the study, 96.6% vs. 88.6% had previously been HCV screened (AOR=3.11; 95% CI: 1.11-8.65), 79.3% vs. 80.9% were antibody positive, and 70.7% vs. 67.6% were HCV-RNA positive or cured with treatment; among the latter, 36.6% vs. 18.2% had started treatment (AOR=2.41; 95% CI: 1.09-5.34), and 20.6% vs. 9.1% had been cured by treatment, respectively. Unawareness of having hepatitis C was more common among migrants than Spanish-born PWID (46.0% and 31.5%, respectively; p<0.05).

Conclusion: This study estimates the HCV care cascade among Spanish-born and migrant PWID in Catalonia for the very first time, and highlights a higher attrition of migrant PWID in all HCV care cascade stages. The observed limited linkage to care and treatment by PWID that attend the HRS network warrants future implementation of decentralized diagnosis and antiviral treatment. Strategies focusing on migrants by increasing HCV screening coverage and treatment access will be especially relevant in our setting.

Keywords: Cascade of care; Harm reduction services (HRS); Hepatitis C virus (HCV); migrants; people who inject drugs (PWID).

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Conflict of interest statement

Declarations of Interest VS: travel sponsorship to attend scientific meetings from Gilead Sciences and Cepheid. EM: advisory board member, research grants, speaking fees as well as travel sponsorship for meetings from Gilead Sciences; research grants and travel sponsorship for presentation of results at meetings from Abbott GmbH & Co. K.G; speaking fees and grant support from Cepheid. The other authors have no competing interests to declare.

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