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. 2022 Apr;42(4):775-786.
doi: 10.1111/liv.15191. Epub 2022 Feb 18.

Feasibility and effectiveness of HCV viraemia testing at harm reduction sites in Georgia: A prospective three-arm study

Sonjelle Shilton  1 , Jessica Markby  1 , Maia Japaridze  1 , Violet Chihota  1 , Shaun Shadaker  2 , Lia Gvinjilia  3 , Maia Tsereteli  4 , Maia Alkhazashvili  4 , Maia Butsashvili  5 , Ketevan Stvilia  4 , Ryan Jose Ruiz 3rd  1 , Alexander Asatiani  4 , Ekaterine Adamia  6 , Philippa Easterbrook  7 , Irma Khonelidze  4 , Amiran Gamkrelidze  4
Affiliations

Feasibility and effectiveness of HCV viraemia testing at harm reduction sites in Georgia: A prospective three-arm study

Sonjelle Shilton et al. Liver Int. 2022 Apr.

Abstract

Background and aims: In 2015, Georgia began a hepatitis C virus (HCV) elimination programme. Although screening programmes have been decentralized for high-risk groups, viraemic testing remains a bottleneck for people who inject drugs. Here, we describe two models of viraemic testing that aimed to address this gap.

Methods: We assigned eight harm reduction sites (HRS) to one of three arms (2,1:1): Xpert HCV viral load testing on-site, blood draw on-site with centralized HCV core antigen testing (HCVcAg), or standard-of-care (SOC) referral with viremia testing performed at treatment centres.

Results: 1671 HCV-seropositive participants were enrolled (Xpert, 37.1%; HCVcAg, 29.1%; referral, 33.8%). Participants were predominantly male (95.4%), mean age (IQR) 43 (37, 50) years and 1290 (77.2%) were currently injecting drugs. Significantly higher proportions of participants in the Xpert (100%) and HCVcAg (99.8%) arms received viraemia testing compared with the referral arm (91.3%) (Xpert vs referral, p < 0.0001; HCVcAg vs referral, p < 0.0001). Among viraemic participants, treatment uptake was similar (Xpert, 84.0%; HCVcAg, 79.5%; referral, 88.4%). The time between screening and sample collection for viraemia testing was significantly longer in the referral arm compared with both Xpert and HCVcAg arms (median 1 day compared with 0 days respectively), and the overall time between screening to treatment initiation was longer for the referral arm (median 67 days) compared with both Xpert and HCVcAg arms (median 57 and 50 days respectively).

Conclusions: Point-of-care viraemia testing and blood drawn on-site for HCVcAg testing yielded more HCV-seropositive patients receiving viraemic testing within a shorter timeframe compared with referrals.

Keywords: Hepatitis C; People who inject drugs; decentralized viremia testing; linkage to care.

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Conflict of interest statement

All authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Setting and location of study sites
FIGURE 2
FIGURE 2
Clinical care pathways
FIGURE 3
FIGURE 3
Retention of patients in the hepatitis C care cascade by study arm
See this image and copyright information in PMC

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