A peer-delivered mobile model to enhance access to hepatitis C point-of-care testing and treatment: The Peers on Wheels study

BACKGROUND: Peer-based models supporting testing and treatment for hepatitis C virus (HCV) infection have been explored, but peer-led testing is less common. We examined HCV testing and treatment following a mobile peer-led intervention integrating incentives, peer-delivered point-of-care HCV RNA testing, and linkage to care. METHODS: Peers On Wheels is an observational study of peer-led mobile outreach integrating incentives, peer-delivered point-of-care HCV antibody and RNA testing, same-day receipt of test results, and peer-assisted linkage to care and treatment to people at HCV risk. Participants were recruited between July 2022 and May 2023 in New South Wales, Australia. The study was co-designed and implemented by a peer-based organisation representing people who use drugs. The primary outcomes were the number of tests performed and the proportion of people who initiated treatment within 12 weeks of testing. RESULTS: 674 participants received HCV point-of-care testing (median age, 45 years, 43% female), 48% injecting drug use ever, and 29% injecting in the previous 6 months. 84% (563 of 674) had no previous HCV treatment and received an antibody test, 20% (113 of 563) tested antibody positive, and 100% (113 of 113) received a reflex point-of-care RNA test. 16% (111 of 674) had previous HCV treatment and received immediate point-of-care RNA testing. HCV antibody prevalence was 33% (221 of 674) and was higher among people who had injected in the previous six months (73%, p < 0.001), and people who had injected, but not in the last six months (53%, p < 0.001) compared to people who had never injected drugs (3%). HCV RNA prevalence was 8% (53 of 674) and was higher among people who had injected in the previous six months (19%, p < 0.001), and people who had injected, but not in the last six months (10%, p < 0.001) compared to people who had never injected drugs (1%). Among people with current HCV, 19% (10 of 53) initiated treatment through the study. CONCLUSIONS: This peer-led mobile model facilitated testing and diagnosis, but a low proportion initiated HCV treatment. Further strategies should be explored to enhance linkage to treatment.