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      Increased Hepatitis C virus screening, diagnosis and linkage to care rates among people who use drugs through a patient‐centered program from Italy

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          Abstract

          Background

          Rates of Hepatitis C virus (HCV) testing and diagnosis are variable among people who use drugs (PWUD). In Puglia in 2018, of 871 subjects screened, 38% had HCV antibodies (HCVAb). Despite sustained virologic response at week 12 Sustained virologic response (SVR12) rates >95%, addiction centers in Italy are not allowed to prescribe direct‐acting antivirals (DAA).

          Aim

          To increase testing and linkage to care a dedicated program including “ad hoc” transportation and fast‐track access to care was offered to PWUD from Puglia.

          Methods

          Over 12 months, 1,470 individuals seen at 15 Services for Dependence (SERDs) underwent screening. For HCVAb positive, a fast‐track evaluation was offered at our Hepatology Unit. Patients were subsequently taken to their pharmacists to receive the prescribed DAA regimen. Treatment and adherence were supervised by SERDs physicians, SVR12 assessed at our unit. The scalability of the process was based on both, number of patients screened in our region in 2018, and number of PWUD diagnosed and treated at our center during 2018–2019.

          Results

          Of 1,470 individuals screened, 634 (43.1%) tested HCVAb positive. Overall, 231 were RNA positive, 54% of whom on opioid agonist therapy (OAT) and 32% with cirrhosis. Median interval between RNA assessment and treatment start was 22 days (0–300). Patients received 12‐week sofosbuvir/velpatasvir regimen without Ribavirin; in 220 patients who completed treatment, SVR12 was 98.6%. Among GT3, SVR12 was 98%. No re‐infection was observed. Improvements in screening, and linkage to care were registered.

          Conclusions

          A PWUD‐tailored service led to HCV care cascade improvement and high SVR12 rates. Despite history of drug addiction, social instability and logistic barriers, micro‐elimination programs providing dedicated care are key drivers of success.

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          Most cited references33

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          EASL recommendations on treatment of hepatitis C: Final update of the series☆

          Hepatitis C virus (HCV) infection is a major cause of chronic liver disease, with approximately 71 million chronically infected individuals worldwide. Clinical care for patients with HCV-related liver disease has advanced considerably thanks to an enhanced understanding of the pathophysiology of the disease, as well as developments in diagnostic procedures and improvements in therapy and prevention. These therapies make it possible to eliminate hepatitis C as a major public health threat, as per the World Health Organization target, although the timeline and feasibility vary from region to region. These European Association for the Study of the Liver recommendations on treatment of hepatitis C describe the optimal management of patients with recently acquired and chronic HCV infections in 2020 and onwards.
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            Micro-elimination – A path to global elimination of hepatitis C

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              The Micro-Elimination Approach to Eliminating Hepatitis C: Strategic and Operational Considerations.

              The introduction of efficacious new hepatitis C virus (HCV) treatments galvanized the World Health Organization to define ambitious targets for eliminating HCV as a public health threat by 2030. Formidable obstacles to reaching this goal can best be overcome through a micro-elimination approach, which entails pursuing elimination goals in discrete populations through multi-stakeholder initiatives that tailor interventions to the needs of these populations. Micro-elimination is less daunting, less complex, and less costly than full-scale, country-level initiatives to eliminate HCV, and it can build momentum by producing small victories that inspire more ambitious efforts. The micro-elimination approach encourages stakeholders who are most knowledgeable about specific populations to engage with each other and also promotes the uptake of new models of care. Examples of micro-elimination target populations include medical patients, people who inject drugs, migrants, and prisoners, although candidate populations can be expected to vary greatly in different countries and subnational areas.
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                Author and article information

                Contributors
                a.mangia@tin.it
                Journal
                United European Gastroenterol J
                United European Gastroenterol J
                10.1002/(ISSN)2050-6414
                UEG2
                United European Gastroenterology Journal
                John Wiley and Sons Inc. (Hoboken )
                2050-6406
                2050-6414
                26 October 2021
                December 2021
                : 9
                : 10 ( doiID: 10.1002/ueg2.v9.10 )
                : 1109-1118
                Affiliations
                [ 1 ] Liver Unit IRCCS “Casa Sollievo della Sofferenza” San Giovanni Rotondo Italy
                [ 2 ] Addiction Department AS Matera Matera Italy
                [ 3 ] Addiction Department ASREM Molise Termoli Italy
                [ 4 ] Territorial Internal Medicine ASL Bari Bari Italy
                [ 5 ] Internal Medicine Ospedale “M. Sarcone” Terlizzi Italy
                [ 6 ] Addiction Department ASL Foggia San Nicandro Italy
                [ 7 ] Addiction Department ASL Foggia Vieste Italy
                [ 8 ] Addiction Department ASL Foggia Manfredonia Italy
                [ 9 ] Addiction Department ASL Foggia Torremaggiore Italy
                Author notes
                [*] [* ] Correspondence

                Alessandra Mangia, Liver Unit, IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, Italy.

                Email: a.mangia@ 123456tin.it

                Author information
                https://orcid.org/0000-0002-2600-3555
                Article
                UEG212156
                10.1002/ueg2.12156
                8672087
                34697911
                b11dacf0-26ea-41be-b29f-16d053e86e54
                © 2021 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC. on behalf of United European Gastroenterology.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 14 May 2021
                : 13 August 2021
                Page count
                Figures: 4, Tables: 3, Pages: 10, Words: 6406
                Funding
                Funded by: Gilead Sciences , doi 10.13039/100005564;
                Award ID: IN‐IT‐987‐5481
                Categories
                Original Article
                Hepatobiliary
                Custom metadata
                2.0
                December 2021
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.7.0 mode:remove_FC converted:15.12.2021

                antiviral treatment,cirrhosis,hcv,hepatitis c,linkage to care,micro‐elimination,people who use drugs,pwud,screening,sofosbuvir/velpatasvir

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