Externalized nurse-led model for hepatitis C virus microelimination and impact of drug use profile

Gastroenterol Hepatol. 2025 May;48(5):502288. doi: 10.1016/j.gastrohep.2024.502288. Epub 2024 Nov 14.
[Article in English, Spanish]

Abstract

Background and objective: Direct-acting antivirals have greatly simplified the treatment of hepatitis C virus (HCV), yet circuits that bring diagnosis and treatment closer to people who inject drugs (PWID) are needed to achieve the elimination targets of the WHO. With this purpose we have established an externalized nurse-driven circuit among former and active PWID in an addiction centre (AC) and a harm reduction centre (HRC).

Methods and settings: The nursing staff offered HCV screening, diagnosis and treatment to the AC and HRC users, administered medication after the hepatologist's remote prescription to those with an active infection who accepted being treated, and implemented educational and harm reduction interventions.

Participants and results: Between October 2018 and March 2021, 566 users accepted screening. 134 (24%) had an active infection, with a higher prevalence among HRC users (42% vs 17%; p<0.001), who were more frequently foreigners, homeless and reported active drug use and syringe sharing. Treatment initiation was similar between groups. Overall sustained viral response (SVR) for intention-to-treat (ITT) and per protocol (PP) was 70% and 88% respectively. Overall adherence was good in both groups; however, SVR was higher in AC users compared to HRC users (ITT-SVR 81% vs 55%). All reinfections (6% by ITT) occurred in the HRC group. Overall loss to follow-up rate was 21%.

Conclusions: This patient-centred nurse-driven circuit demonstrates that HCV treatment can be successfully delivered to PWID even with active drug use and socio-economic complexity. User-specific characteristics need to be considered when setting up these interventions to maximize success.

Keywords: Antivirales de acción directa; Direct-acting antivirals; Drogodependencia; Drug dependence; Enfermería; Harm reduction; Hepatitis C; Nursing; People who inject drugs; Reducción de daños; Reinfección; Reinfection; Usuarios de drogas por vía inyectada.

MeSH terms

  • Adult
  • Antiviral Agents* / therapeutic use
  • Female
  • Harm Reduction
  • Hepatitis C* / diagnosis
  • Hepatitis C* / drug therapy
  • Hepatitis C* / nursing
  • Humans
  • Male
  • Middle Aged
  • Models, Nursing*
  • Practice Patterns, Nurses'*
  • Substance Abuse Treatment Centers
  • Substance Abuse, Intravenous* / complications
  • Substance Abuse, Intravenous* / nursing
  • Sustained Virologic Response

Substances

  • Antiviral Agents