A peer-delivered mobile model to enhance access to hepatitis C point-of-care testing and treatment: The Peers on Wheels study.

BACKGROUND

Peer-based models supporting testing and treatment for hepatitis C virus (HCV) infection have been explored, but peer-led testing is less common. We examined HCV testing and treatment following a mobile peer-led intervention integrating incentives, peer-delivered point-of-care HCV RNA testing, and linkage to care.

METHODS

Peers On Wheels is an observational study of peer-led mobile outreach integrating incentives, peer-delivered point-of-care HCV antibody and RNA testing, same-day receipt of test results, and peer-assisted linkage to care and treatment to people at HCV risk. Participants were recruited between July 2022 and May 2023 in New South Wales, Australia. The study was co-designed and implemented by a peer-based organisation representing people who use drugs. The primary outcomes were the number of tests performed and the proportion of people who initiated treatment within 12 weeks of testing.

RESULTS

674 participants received HCV point-of-care testing (median age, 45 years, 43% female), 48% injecting drug use ever, and 29% injecting in the previous 6 months. 84% (563 of 674) had no previous HCV treatment and received an antibody test, 20% (113 of 563) tested antibody positive, and 100% (113 of 113) received a reflex point-of-care RNA test. 16% (111 of 674) had previous HCV treatment and received immediate point-of-care RNA testing. HCV antibody prevalence was 33% (221 of 674) and was higher among people who had injected in the previous six months (73%, p < 0.001), and people who had injected, but not in the last six months (53%, p < 0.001) compared to people who had never injected drugs (3%). HCV RNA prevalence was 8% (53 of 674) and was higher among people who had injected in the previous six months (19%, p < 0.001), and people who had injected, but not in the last six months (10%, p < 0.001) compared to people who had never injected drugs (1%). Among people with current HCV, 19% (10 of 53) initiated treatment through the study.

CONCLUSIONS

This peer-led mobile model facilitated testing and diagnosis, but a low proportion initiated HCV treatment. Further strategies should be explored to enhance linkage to treatment.