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Accessible, Nonstigmatizing Care Clinic Had Better Hepatitis C Outcomes

Injection drug users who received accessible care treatment at a syringe service program were almost 3 times as likely to complete their hepatitis C treatment than people who received usual care.

Hepatitis C is a blood-borne virus that can cause chronic illness and fatal liver damage. The US Centers for Disease Control and Prevention (CDC) reported that over 14000 people died of hepatitis C in 2019, and as many as 2.5 million people are estimated to be living with the hepatitis C virus (HCV).

As many as 80% of people with hepatitis C are injection drug users, so finding the best way to treat this population is crucial to ending the disease. However, the stigma surrounding injection drugs may prevent some users from seeking medical care.

A recent study, published in JAMA, found that accessible, nonstigmatizing care can significantly improve patient outcomes among adults with hepatitis C. The single-site clinical trial was led by investigators from Weill Cornell Medicine, New York-Presbyterian, NYU Grossman School of Medicine, and the CUNY Graduate School of Public Health and Health Policy.

The trial was conducted from July-2017-March 2021 at the Lower East Side Harm Reduction Center in New York City. The investigators recruited 167 adult participants who were hepatitis C virus (HCV) RNA-positive and had injected drugs in the past 90 days. Of the 167 participants, the average age was 42 years and 77.6% were male. The population was 4.8% Black, 32.1% White, and 58.5% Hispanic.

Participants were randomly assigned 1:1 to either accessible care treatment at a syringe service program or usual care via facilitated referral. The primary study outcome was HCV cure, measured by sustained virologic response. Patient follow-up continued for 1 year after study enrollment.

The hepatitis C cure rate was 86% for both sets of participants who completed their treatment, but 67.1% of those enrolled at the syringe service program completed their treatment, as opposed to only a 22.9% completion rate for those assigned to usual care.

Usual care facilities are often not conducive to or openly reject people who inject drugs. Traditional healthcare clinics may require patients to stop using injection drugs before they can receive treatment, which the study authors note is unnecessary and serves to bar these people from care. “People who presently inject drugs can be cured,” said Benjamin Eckhardt, MD, a first author of the study, an assistant professor at NYU Grossman School of Medicine, and an infectious disease specialist at NYU Langone Health.

Logistical barriers also prevent injection drug users from accessing traditional care settings, as many people who inject drugs are homeless or lack the transportation to get to a clinic, leading to them missing appointments and getting dropped from care. Accessible care treatment centers, like the one in this study, often have “walk-in” hours and reach out to patients who miss appointments.

The main draw of the Lower East Side Harm Reduction Center appeared to be this flexibility. Eckhardt said he was surprised that people from the Bronx and Brooklyn came to Manhattan to participate in the unique and inclusive care the clinic offered. “It was less about the location and more about the comfort this population had with the site,” Eckhardt explained.

The investigators concluded that the low-threshold, nonstigmatizing hepatitis C treatment program was associated with significantly higher rates of cure. “To achieve hepatitis C elimination,” they wrote, “expansion of treatment programs that are specifically geared toward engaging people who inject drugs is paramount