Decentralised same day test and treatment of hepatitis C levering existing peer support networks among people who inject drugs: Feasibility and effectiveness

Background Prevalence of hepatitis C virus (HCV) infection among people who inject drugs in the state of Manipur, India, is 43%; however, access to care is poor. We piloted a Community-led and comprehensive hepatitis care model that included same-day HCV treatment at drug treatment centres. Methods Screening was conducted using HCV antibody (HCV Ab) and hepatitis B virus (HBV) surface antigen (HBsAg) rapid diagnostic tests. Positive HCV Ab samples were tested using a point-of-care HCV RNA. Eligible HCV RNA-positive participants were treated on the same day using direct-acting antivirals and followed for sustained virologic response (SVR). HBsAg-negative participants received rapid HBV vaccination regimen while positive samples were tested for DNA and referred for treatment. Results Between November 2021 and August 2022, 643 individuals were approached and 503 consented and were screened. All screened were males with history of injection drug use, and a median age of 27 years (IQR 23–32). Of the 241 (47.9%) HCV Ab positive all underwent RNA testing and 156 (64.7%) were RNA detectable. Of those with viraemia, 155 (99.4%) were initiated on treatment with 153 (98.1%) on same day. Among those 153, median time from screening to treatment was 6 hours 38 minutes (IQR 5 hours 42 minutes – 8 hours 23 minutes). In total 155 (100%) completed HCV treatment, of those 148 (95.5%) completed SVR testing and 130 (87.8%) achieved SVR12.