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. 2024 Feb 28;16(3):375.
doi: 10.3390/v16030375.

Integration of Hepatitis C and Addiction Treatment in People Who Inject Drugs: The San Patrignano HCV-Free and Drug-Free Experience

Pierluca Piselli  1 , Antonio Boschini  2 , Romina Gianfreda  3 , Alessandra Nappo  1 , Claudia Cimaglia  1 , Gianpaolo Scarfò  1 , Camillo Smacchia  2 , Raffaella Paoletti  2 , Sarah Duehren  2 , Enrico Girardi  1
Affiliations

Integration of Hepatitis C and Addiction Treatment in People Who Inject Drugs: The San Patrignano HCV-Free and Drug-Free Experience

Pierluca Piselli et al. Viruses. .

Abstract

Injection drug use represents an important contributor to hepatitis C virus (HCV) transmission, hence therapeutic communities (TCs) are promising points of care for the identification and treatment of HCV-infected persons who inject drugs (PWIDs). We evaluated the effectiveness and efficacy of an HCV micro-elimination program targeting PWIDs in the context of a drug-free TC; we applied the cascade of care (CoC) evaluation by calculating frequencies of infection diagnosis, confirmation, treatment and achievement of a sustained virological response (SVR). We also evaluated the risk of reinfection of PWIDs achieving HCV eradication by collecting follow-up virologic information of previously recovered individuals and eventual relapse in drug use, assuming the latter as a potential source of reinfection. We considered 811 PWIDs (aged 18+ years) residing in San Patrignano TC at the beginning of the observation period (January 2018-March 2022) or admitted thereafter, assessing for HCV and HIV serology and viral load by standard laboratory procedures. Ongoing infections were treated with direct-acting antivirals (DAA), according to the current national guidelines. Out of the 792 individuals tested on admission, 503 (63.5%) were found to be seropositive for antibodies against HCV. A total of 481 of these 503 individuals (95.6%) underwent HCV RNA testing. Out of the 331 participants positive for HCV RNA, 225 were ultimately prescribed a DAA treatment with a sustained viral response (SVR), which was achieved by 222 PWIDs (98.7%). Of the 222 PWIDs, 186 (83.8%) with SVR remained HCV-free on follow-up (with a median follow-up of 2.73 years after SVR ascertainment). The CoC model in our TC proved efficient in implementing HCV micro-elimination, as well as in preventing reinfection and promoting retention in the care of individuals, which aligns with the therapeutic goals of addiction treatment.

Keywords: HCV; cascade of care; intravenous drug use; therapeutic community.

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Conflict of interest statement

Antonio Boschini has received institutional grants from Gilead Science. None of the other authors have any conflicts of interest to report.

Figures

Figure 1
Figure 1
HCV screening in 811 PWIDs assisted at San Patrignano community (2018–2022) and results of the cascade of care for HCV. PWIDs: people who inject drugs; HCV: hepatitis C virus; HCV Ab: HCV antibodies; HCV RNA: HCV ribonucleic acid; DAA: direct-acting antivirals; EoTR: end of treatment response; SVR12: sustained virological response at 12 weeks after DAA end of treatment.
Figure 2
Figure 2
Cascade of care for HCV in PWIDs assisted at San Patrignano community (2018–2022). PWIDs: people who inject drugs; HCV: hepatitis C virus; HCV Ab: HCV antibodies; HCV RNA: HCV ribonucleic acid; DAA: direct-acting antivirals; SVR12: sustained virological response at 12 weeks after DAA end of treatment.
Figure 3
Figure 3
Follow-up information on 222 PWIDs cured of HCV at San Patrignano community (2018–2022). PWIDs: people who inject drugs; HCV: hepatitis C virus; FUP: follow-up; No Rel: no relapse to drug use; SVR12: sustained virological response at 12 weeks after DAA end of treatment.
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