CHIME – an HCV microelimination project based on tailored screening and treatment of PWIDs on opioid agonist therapy in Vienna

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Background Despite the availability of modern direct-acting antiviral (DAA) treatment regimens, the prevalence of chronic hepatitis C remains high among people who inject drugs (PWIDs). Through the CHIME project, individualized HCV screening and treatment were offered to 6,665 PWIDs on opioid agonist therapy (OAT) in Vienna. Methods Through the OAT program, Viennese PWIDs were required to have their OAT prescriptions approved at one of nine central awarding authorities every month, rendering these institutions ideal screening platforms for HCV (hepatitis C virus). On-site anti-HCV screening and follow-up HCV-RNA PCR in case of anti-HCV seropositivity were offered to all PWIDs attending these awarding authorities. DAA treatment was administered alongside OAT according to the concept of directly observed therapy (DOT) in PWIDs with HCV viremia. Results 4,327/6,665 (64.9%) PWIDs were contacted before the project ended prematurely due to the COVID19 pandemic. 1,538/4,327 (35.5%) chose to participate in the project, and in 1,510 (98.2%) an HCV serology was available. 795/1,519 (52.6%) showed anti-HCV (+), 632 (79.5%) of which received a consecutive PCR test. Additionally, 8/1,538 (0.5%) were assessed via HCV-RNA PCR without prior anti-HCV screening. 239/640 (37.3%) had HCV viremia, in 51 (21.3%) of which DAA treatment could already be established despite ongoing social restrictions associated with the COVID19 pandemic, which complicated the process of treatment initiation. In 48/51 (94.1%), treatment was already completed, in 42 (87.5%) of whom SVR12 was documented. 6 (12.5%) PWIDs were lost to follow-up after end of treatment. Conclusion On-site HCV screening at central OAT approval centers combined with DAA treatment according to DOT is an effective HCV microelimination strategy in Viennese PWIDs. While overall SVR rates were impacted by the COVID19 pandemic, the project has facilitated linkage to HCV care in a large cohort of PWIDs in Vienna. Publication History Article published online: 24 May 2023 © 2023. Thieme. All rights reserved. Georg Thieme Verlag Rüdigerstraße 14, 70469 Stuttgart, Germany

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