Integrating HCV testing with HIV programs improves hepatitis C outcomes in people who inject drugs: A cluster-randomized trial

Abstract Background & Aims We evaluated the impact of integrating HCV testing/education into integrated care centers (ICCs) delivering HIV services to people who inject drugs (PWID) across India using a cluster-randomized trial. Methods We compared ICCs with usual care (UC) in the PWID stratum (12 sites) of a 22-site cluster-randomized trial. In 6 sites, ICCs delivering HIV testing, harm reduction, other preventive services and linkage to HIV treatment were scaled from opioid agonist therapy centers and operated for two years. On-site rapid HCV antibody testing was integrated after one year. To assess impact, we conducted baseline and evaluation surveys using respondent-driven sampling (RDS) across the 12 sites (n=11,993 recruited at baseline; n=11,721 recruited at evaluation). The primary outcome was population-level self-reported HCV testing history. Results At evaluation, HCV antibody prevalence ranged from 7.2%-76.6%. Across 6 ICCs, 5,263 ICC clients underwent HCV testing, of whom 2,278 were newly diagnosed. At evaluation, PWID in ICC clusters were four times more likely to report being tested for HCV than UC clusters adjusting for baseline testing (adjusted prevalence ratio [aPR]: 3.69; 95% confidence interval [CI]: 1.34, 10.2). PWID in ICC clusters were also 7 times more likely to be aware of their HCV status (aPR: 7.11; 95% CI: 1.14, 44.3) and significantly more likely to initiate treatment (aPR: 9.86; 95% CI: 1.52, 63.8). Conclusions We provide among the first empirical support for integrating HCV testing with HIV/harm reduction services. To achieve elimination targets, programs will need to scale-up such venues to deliver comprehensive HCV services. Lay summary Delivering HCV testing to people who inject drugs (PWID) in places where they also have access to HIV prevention and treatment services is an effective way to improve uptake of HCV testing among communities of PWID.