Getting to the Point: A Community-Designed, Low-Barrier Hepatitis C Testing and Treatment Program for People Who Inject Drugs in Rural America.

BACKGROUND

People who inject drugs (PWID) have a higher risk of contracting hepatitis C (HCV) than the general population, but these individuals are often poorly served by traditional healthcare systems. The elimination of HCV as a threat to public health relies on the treatment of this population. Novel care models designed with input from PWID may help to better align care to the needs of PWID.

METHODS

We designed and implemented a community-based, point-of-care testing program for HCV delivered by a syringe service program, combined with facilitated access to a healthcare provider, care navigation, and financial incentives. We collected participant demographics and drug use patterns, testing and treatment history, and communication preferences. Descriptive analyses include the number of people tested between 15 October 2021 and 1 February 2025, their seropositivity rate, and the number who completed pre-treatment laboratory tests, completed treatment and achieved cure by sustained virologic response (SVR12) by 1 August 2025.

RESULTS

The program engaged 464 unique individuals, of whom 98 (21.1%) had a known diagnosis of HCV. Of 389 unique individuals who underwent point of care (POC) HCV antibody (Ab) testing, including 31 with a known prior diagnosis of HCV, 97 (24.9%) had a positive result. Of 439 unique individuals who underwent POC HIV Ab testing, only 1 had a positive result. Of 164 individuals with either a positive POC HCV Ab test or a known HCV diagnosis, 66 completed pre-treatment laboratory tests, identifying 52 viremic participants. Of those, 35 started and completed treatment. Among those who completed treatment, 9 (25.7%) achieved SVR12, 3 (8.6) failed to achieve SVR12, and 23 (65.7%) had outstanding laboratory orders for SVR12 determination.

CONCLUSIONS

An incentivized, community-based, point-of-care testing program with facilitated linkage to care successfully engaged a high-risk population in HCV and HIV testing and treatment. However, substantial attrition occurred at each step of the care cascade, particularly at SVR12 determination. Additional strategies are needed to optimize retention throughout the entire care cascade.