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. 2018 Jul 17;1(2):14-33.
doi: 10.3138/canlivj.1.2.002. eCollection 2018 Spring.

Diagnosis and treatment of hepatitis C virus infection: a tool for engagement with people who inject drugs in Vancouver's Downtown Eastside

Arshia Alimohammadi  1   2 , Julie Holeksa  1   2 , Robyn Parsons  1 , Rossita Yung  1 , Neilofar Amiri  1 , David Truong  1 , Brian Conway  1
Affiliations

Diagnosis and treatment of hepatitis C virus infection: a tool for engagement with people who inject drugs in Vancouver's Downtown Eastside

Arshia Alimohammadi et al. Can Liver J. .

Abstract

Background: Vancouver's Downtown Eastside (DTES) faces the interrelated challenges of poverty, homelessness, mental health, addiction, and medical issues such as hepatitis C virus (HCV). This study evaluates a new model of engagement with people who inject drugs (PWID) in the DTES.

Methods: Our centre has developed the community pop-up clinic (CPC) to engage vulnerable populations such as PWID. Rapid HCV testing is offered using the OraQuick saliva assay. If a test is positive, immediate medical consultation and an incentivized clinic appointment are offered. At this appointment, an HCV treatment plan is developed, along with a plan for engagement in multidisciplinary care.

Results: In 12 months, 1,283 OraQuick tests were performed at 44 CPCs; 21% of individuals were found to be positive for HCV (68% of whom were PWID). Of individuals positive for HCV antibodies who consulted with the on-site doctor, 50% engaged in care in our clinic-61% of whom have initiated interferon-free directly acting antiviral (DAA) HCV therapy with 100% cured of HCV (per protocol). Individuals who did not engage in care were significantly more likely to be homeless (P < .0001).

Conclusion: CPCs paired with a multidisciplinary model of care address the needs of vulnerable populations such as PWID, particularly in the management of HCV with interferon-free DAA therapies.

Keywords: community outreach; interferon-free DAA HCV therapy; marginalized populations; opioid epidemic.

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Conflict of interest statement

Dr. Conway reports grants, honouraria, personal fees, and nonfinancial support from Merck & Co, Abbvie, Gilead Sciences, and Viiv. Mr. Alimohammadi reports personal fees and nonfinancial support from Merck & Co., Abbvie, and Gilead Sciences. Dr. Truong reports personal fees and nonfinancial support from Merck & Co. Ms. Holeksa reports grants from Merck & Co., during the conduct of the study. Ms Parsons reports grants from Merck & Co., during the conduct of the study. Ms Yung reports grants from Merck & Co., during the conduct of the study.

Figures

Figure 1:
Figure 1:
A typical community pop-up clinic flowchart HCV = Hepatitis C virus; VIDC = Vancouver Infectious Diseases Centre
Figure 2:
Figure 2:
Cascade of care for individuals found to be HCV antibody positive at CPCs (August 2016–August 2017) CPCs = Community pop-up clinics; HCV = hepatitis C virus; VIDC = Vancouver Infectious Diseases Centre
Figure 3:
Figure 3:
Patient engagement (August 2016–August 2017) HCV = hepatitis C virus
See this image and copyright information in PMC

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