New direct-acting antivirals promise high cure rates for the majority of patients with chronic HCV; however, it is unknown whether high cure rates will be obtained in clinical practice, particularly among persons who use drugs (PWUDs). We investigated the effectiveness of onsite treatment with care coordination for patients that access primary care at an urban federally qualified health center (FQHC), and we explored differences in HCV cure rates for PWUD versus non-PWUD.
Onsite HCV treatment occurred once weekly by an HCV specialist at an FQHC in the Bronx, NY. An HCV care coordinator, funded by the NYC Department of Health’s Check Hep C Program, was responsible for patient scheduling, reminder calls, health education, and obtaining prior authorizations. We identified 114 patients with an HCV evaluation from January 2014- February 2015, and reviewed medical records for patients who initiated HCV treatment. Patients were categorized as PWUD if they were receiving opioid agonist therapy (OAT) or noted to have active drug use in the medical chart or urine toxicology. Chi-square testing was performed to determine differences in HCV cure between PWUD and non-PWUD.
114 patients were evaluated for HCV and 67 (59%) initiated HCV treatment during the study time frame. Treatment patients were mostly male (64%), Latino or African American (82%), with a median age of 60. 21% were HCV treatment experienced, 22% were HIV/HCV co-infected, and 24% had cirrhosis. Over half of the patients were PWUD (52%). 28 patients were on OAT (15 on methadone, 13 on buprenorphine) and 24 patients were actively using drugs during HCV care. The majority of the patients were genotype 1 (93%) and all were treated with sofosbuvir-based regimens. The overall HCV cure rate was 94% (63/67), and there were no differences in cure rates for PWUD (94%, 33/35) versus non-PWUD (94%, 30/32, p=0.5).
Suboptimal HCV treatment of PWUD contributes to growing HCV-related morbidity and mortality, and maintains a continued reservoir for HCV infection. Among PWUD who received care coordinator assisted sofosbuvir-based therapy at an urban FQHC, HCV cure rates were high, and no different than for non-PWUD. On-site treatment with care coordination may help to mitigate barriers to specialty care and improve HCV cure rates for PWUD. Similar treatment models should be replicated and tested throughout the 1200 FQHCs in the United States, settings that are known to serve high numbers of PWUD.