Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

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

Pierluca Piselli
* ORCID logo ,
Antonio Boschini
ORCID logo ,
Romina Gianfreda
,
Alessandra Nappo
,
Claudia Cimaglia
,
Gianpaolo Scarfò
,
Camillo Smacchia
,
Raffaella Paoletti
,
Sarah Duehren
,
Enrico Girardi
ORCID logo
Version 1 : Received: 19 January 2024 / Approved: 19 January 2024 / Online: 19 January 2024 (14:43:54 CET)

A peer-reviewed article of this Preprint also exists.

Piselli, P.; Boschini, A.; Gianfreda, R.; Nappo, A.; Cimaglia, C.; Scarfò, G.; Smacchia, C.; Paoletti, R.; Duehren, S.; Girardi, E. Integration of Hepatitis C and Addiction Treatment in People Who Inject Drugs: The San Patrignano HCV-Free and Drug-Free Experience. Viruses 2024, 16, 375. Piselli, P.; Boschini, A.; Gianfreda, R.; Nappo, A.; Cimaglia, C.; Scarfò, G.; Smacchia, C.; Paoletti, R.; Duehren, S.; Girardi, E. Integration of Hepatitis C and Addiction Treatment in People Who Inject Drugs: The San Patrignano HCV-Free and Drug-Free Experience. Viruses 2024, 16, 375.

Abstract

Persons who inject drugs (PWIDs) represent an important reservoir of hepatitis C virus (HCV) infection, hence therapeutic communities (TCs) are promising points of care for the identification and treatment of HCV-infected PWIDs. We evaluated the effectiveness and efficacy of an HCV micro-elimination program targeting PWIDs in the context of a drug-free TC applying 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 all PWIDs (aged 18+ years) residing in the San Patrignano TC at the beginning of the observation period (Jan/2018–Mar/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. 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%). 186 of 222 PWIDs (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 care of individuals, which aligns with the therapeutic goals of addiction treatment.

Keywords

HCV; cascade of care; therapeutic community; intravenous drug use

Subject

Medicine and Pharmacology, Epidemiology and Infectious Diseases

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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