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Approaches to Offering Hepatitis C Treatment at Syringe Services Programs in the United States: A Scoping Review
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Studies have shown that PWID prefer care in locations that are affirming and convenient [14-16]. Many programs outside the United States have demonstrated successful integration of HCV treatment with syringe service programs (SSPs) [17-19]. Examples of integrated models of HCV care with SSPs in the United States are more limited but have also shown benefit and promise [20]. The standard of care for HCV treatment for PWID includes referrals to gastroenterologists, infectious diseases specialists, and HCV-trained primary care providers in traditional clinic settings [21]. This clinic-based approach to HCV treatment has not met the needs of many PWID, with HCV treatment initiation rates of 5.5%-26% among PWID in various reports, and cure rates that are even lower [10-12]. Not only do traditional, typically high-threshold treatment models present scheduling and transportation challenges, they may also be staffed by providers who have limited experience working with PWID or other individuals with substance use disorders [13].
We conducted a scoping review of published, peer-reviewed literature on approaches to integrating HCV treatment at US SSPs. This review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.We found 13 articles including randomized controlled trials, observational studies, cohort analyses, and qualitative analyses that described a variety of approaches to integration that produced significant improvements in treatment initiation and cure compared with a referral-based standard of care.
All programs described a process for obtaining blood for pretreatment laboratory assessments and required a detectable HCV RNA result before starting treatment.
While SVR12 outcomes were not available for all programs at the time of publication, the programs that did include final results reported cure rates ranging from 54% to 94% of those who enrolled, initiated therapy, and/or completed SVR12 confirmatory labs, depending on the study.
These results demonstrate how SSPs have trusted advocates that serve a highly marginalized community of PWID and are essential public health partners in achieving HCV elimination goals [38].
Although most programs aimed to initiate treatment at the second visit and/or within 2 weeks of screening, Eckhardt et al. demonstrated that rapid initiation with a 7-day starter pack provided on the day of screening was an effective strategy to achieve SVR12.
With the 2024 FDA approval of point-of-care HCV RNA testing that provides results in about an hour, programs may be able to offer a same-day “test and treat” strategy.
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