E. Kågström [1], A. Lannergård [1], J. El Khosht [2], P. Lörelius[2], J. Månflod [2], S. Strömdahl [1]

Affiliates

[1] Department of Medical Sciences, Infectious Diseases, Uppsala University, Sweden [2] Needle and Syringe Exchange Uppsala, Nära Vård och Hälsa, Region Uppsala, Sweden

Abstract

Background and Aims: The World Health Organization has set a goal to reach world elimination of hepatitis B virus (HBV) and hepatitis C virus (HCV) by 2030. Needle and syringe programs (NSP) for people who inject drugs (PWID) are crucial to achieve this goal. The NSP in Uppsala, Sweden, opened in 2016 and has since 2018 provided HCV treatment for PWID. The aim of this study was to investigate HCV prevalence, risk factors, sero-status awareness and treatment uptake and outcome in participants at the NSP.
Method: Data from 450 PWID registered at the Uppsala NSP during the time period 1 November 2016 and 31 December 2021 was collected from the national quality registry InfCare NSP. Data from the 101 PWID treated for HCV at the Uppsala NSP was collected from the national quality InfCare Hepatitis. Descriptive and inferential analysis was performed. Ethical approval was obtained from the Ethical Review Board in Uppsala (dnr 2019/00215).
Results: The mean age was 35 years of which 75% were males (336/450) and 25% were females (114/450). The overall HCV prevalence was 48% (215/450) with a declining trend over time, see figure 1. Regarding pre-testing awareness, 76% (123/161) of those who reported positive HCV status were HCV positive, whilst 28% (17/60) of those who reported unknown HCV status and 12% (28/225) of those who reported negative HCV status were in fact HCV positive. Factors associated with a higher risk of HCV positivity were older age at registration (OR 1.025, 95% CI 1.004 – 1.046), lower age at injection drug debut (OR 0.963, 95% CI 0.932 – 0.996), lower education level (OR 1.829, 95% CI 1.185 – 2.821) and higher number of total visits at the NSP (OR 1.005, 95% CI 1.001 – 1.009). The majority had HCV genotype 1 (51%), followed by genotype 3 (44%). The overall HCV treatment uptake was 47% (101/215), see figure 2. 78 (77%) completed HCV treatment whereas 12 (12%) had ongoing treatment at end of study and 11 (11%) discontinued treatment. Of the 78 participants who completed treatment 99% (78/79) were cured with a sustained virologic response 12 weeks after completed treatment. Over the study period 9 (9%) participants had a HCV re-infection, all were male with mean age of 36.
Conclusion: The HCV prevalence, treatment uptake and treatment outcome has improved since the opening of the Uppsala NSP in 2016. However, further measures are still needed to reduce HCV transmission to reach the global HCV elimination goal. Outreach HCV treatment programs for PWID should be explored and evaluated, in combination with further implementation of low-threshold programs, to facilitate higher NSP enrollment as well as increase HCV treatment uptake and compliance among NSP participants.

Figure 1. HCV-prevalence (%) in total and per registration year.
Figure 2. HCV treatment uptake (%) in total, per home region and per year (treatment year for those treated, year of first positive HCV test for those not treated).