Streamlined HCV Testing and Treatment for Homeless PWID via Mobile Units
Overview
This randomized controlled trial evaluated a simplified hepatitis C virus (HCV) testing and treatment protocol delivered via mobile medical units (MMUs) to unhoused people who inject drugs (PWID). While MMUs facilitated faster treatment initiation compared to usual care, overall treatment initiation, retention, and cure rates remained low, highlighting ongoing challenges in this vulnerable population.
Background
Hepatitis C virus infection disproportionately affects PWID, especially those experiencing homelessness, who face significant barriers to testing and treatment. Despite highly effective direct-acting antivirals, many remain uncured due to difficulties in accessing care. Simplified testing and treatment algorithms, including point-of-care RNA assays and integrated services via mobile clinics, have been proposed to improve outcomes. However, real-world evidence of these approaches in unhoused PWID in urban US settings is limited.
Data Highlights
Outcome
MMU Group (n=98)
Usual Care Group (n=98)
P Value
Treatment Initiation within 6 months
33%
24%
0.4
Treatment Completion
10%
16%
NS
SVR12 (Sustained Virologic Response at 12 weeks)
4%
12%
NS
Key Findings
33% of patients in the MMU group initiated HCV treatment within 6 months versus 24% in usual care, though this difference was not statistically significant (P = .4).
Treatment completion and SVR12 rates were higher in the usual care group (16% and 12%, respectively) compared to the MMU group (10% and 4%), but differences were not statistically significant.
MMUs enabled faster treatment initiation but faced challenges with patient retention and follow-up.
The overall rates of treatment initiation, retention, and cure remained low in both groups, underscoring persistent barriers.
Integration of HCV testing and treatment with harm reduction services via MMUs shows potential but requires further optimization to approximate a test-and-treat model.
Clinical Implications
Mobile medical units can improve rapid access to HCV treatment among unhoused PWID by simplifying testing and linkage to care. However, low treatment completion and cure rates indicate the need for enhanced strategies to improve retention and follow-up. Clinicians should consider integrating HCV care with existing harm reduction services and explore models that minimize delays between diagnosis and treatment initiation.
Conclusion
Simplified HCV testing and treatment delivered via MMUs shows promise for increasing treatment initiation among unhoused PWID but is insufficient alone to achieve high cure rates. Innovative approaches that closely approximate a test-and-treat model are essential to overcome barriers and advance HCV elimination in this vulnerable population.
References
Study Authors/2024 -- Streamlined Hepatitis C Virus Testing and Treatment Protocol for Homeless Individuals Who Inject Drugs
by Christian B Ramers, Natalie Vawter, Adam Northrup, Stacey L Klaman, Sydney V Lewis, Aaron Tam, Carolina Del Aguila, Robert Lewis, Blanca Mendez, Letty Reyes, Eva Matthews, Sarah Rojas, Job G Godino
