HCV Services and Syringe Exchange Programs: Partnering to Improve Access to Care for People Who Inject Drugs

Author: Porter C, Bensley K, Jama S, Ninburg M

Theme: Epidemiology & Public Health Research Year: 2017

Since 2013, the Hepatitis Education Project (HEP) and the People’s Harm Reduction Alliance (PHRA) have partnered to provide free hepatitis C (HCV) antibody screenings and free HCV confirmatory RNA testing to syringe exchange participants in Seattle, WA. The project aims to test persons who inject drugs (PWID) for HCV infection and link them to HCV care and treatment.

HEP provides HCV testing in collaboration with PHRA’s syringe exchange services. Participants are asked about HCV risk behaviors during pre-test counseling. Rapid antibody screening is done using fingerstick blood. A skilled phlebotomist performs onsite blood draws for confirmatory RNA testing. Gift card incentives are provided when participants receive the results of antibody screening and confirmatory testing.

Between June 2013 and April 2017, 420 individuals received HCV antibody screenings, of whom 125 (29.8%) were antibody positive. 91 (72.8%) antibody-positive clients received a confirmatory RNA test, of whom 64 (70.3%) were RNA positive. 44 (68.8%) RNA-positive clients were referred to care, seven (10.9%) attended an appointment with a medical provider, and two (3.1%) are currently engaged in HCV treatment.

Of 420 individuals tested, 264 (62.9%) reported ever using injection drugs, of whom 236 (89.4%) reported use during the previous 12 months. 160 (60.6%) reporting sharing injection drug equipment. Other common risk factors included accidental blood exposure (29.5%), unprotected sex with someone with HCV (22.4%), and receiving a tattoo/piercing using unsterile equipment (18.8%).

Conclusion: Collaboration between HEP and PHRA allows the provision of HCV-related services to a high-risk population in a trusted and established service setting. While the model for HCV testing has proven successful, few clients have been linked to care. Future research is needed to better understand barriers to HCV care and treatment for PWID.

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