High HCV cure rates in C-FREE, first community-based study offering testing and treatment of viral hepatitis and HIV among people who use drugs and their partners in Thailand


BACKGROUND: Among people who inject drugs (PWID) in Thailand, HIV and hepatitis C (HCV) antibody prevalence is estimated at 25% and 70%, respectively. C-Free is a cohort study of community-based testing and treatment of HCV, hepatitis B virus (HBV), and HIV for people who use drugs (PWUD), implemented at six drop-in-centres (DICs) offering harm reduction services in Thailand.
METHODS: Individuals who currently/previously used drug(s), aged at least 18, were screened for HCV, HBV, and HIV. Those with negative hepatitis B surface antigen (HBsAg) and antibody receive HBV vaccination. GeneXpert was utilized to measure HIV RNA, HCV RNA, and HBV DNA on-site, for those with reactive rapid tests. Those with confirmed HIV and HBV infection were referred to existing national programs. Participants with HCV infection without evidence of decompensated cirrhosis, hepatocellular carcinoma, or end stage renal disease, were offered a twelve-week course of sofosbuvir/velpatasvir. Those with negative HIV and/or HCV were offered repeat testing at three-month intervals
RESULTS: Between June 2019 and January 2021, 1,118 participants enrolled, 949 (84.9%) were male, median age was 43 years (range 18-73), and 841 (75.2%) reported a lifetime history of injecting drugs. HCV antibody was detected in 809 (72.4%), HIV antibody in 460 (41.1%), and HbsAg in 54 (4.8%). 72.6% of those with HIV were coinfected with HCV. Among 809 with reactive HCV Ab, 667 (82.45%) had detectable HCV RNA, 226 (39.4%) reported actively injecting drugs, and 60 (9%) had evidence of cirrhosis using an AST to Platelet Ratio (APRI) of 2.0.
Of 652 participants who met HCV treatment eligibility criteria, 573(87.9%) have started sofosbuvir/velpatasvir, 420 (73.3%) have completed treatment, and 353 (61.6%) have reached the sustained virological response (SVR) timepoint. SVR was achieved by 326 participants; 92.4% (95%CI 89-95%) in the intent-to-treat analysis and 95.3% (95%CI 93-97%) of 342 in the per-protocol analysis. No treatment-related serious adverse events were observed.
CONCLUSIONS: Community-based HCV treatment with sofosbuvir/velpatasvir for PWUD in Thailand, within harm reduction settings, is safe and highly effective. National programs should urgently integrate community-based HIV and HBV/HCV test and treat services as standard of care for drug-using populations to decrease morbidity and onward transmission of these infections.