Community-based integrated care for HIV, viral hepatitis and sexually transmitted infections, Thailand

Objective: To assess the impact of an integrated model of care in curing hepatitis C in people who use drugs in Thailand. Methods: The C-Free Study enrolled people with current or prior drug use and their partners in a prospective cohort at community drop-in centres providing harm reduction services. Participants were screened for human immunodeficiency virus (HIV), hepatitis C virus (HCV), hepatitis B virus (HBV) and sexually transmitted infections. Eligible participants with HCV infection received a 12-week course of sofosbuvir-velpatasvir. The main impact outcome was sustained virological response, measured 12 weeks after treatment completion. Results: Between June 2019 and April 2023, we enrolled 2871 participants in 10 sites across Thailand: 1601 (55.8%) had HCV antibodies; 1275 (44.4%) had active HCV infection; 846 (29.5%) had HIV; and 221 (7.7%) had HBV. Of 1134 participants with active HCV who started treatment with sofosbuvir-velpatasvir, 939 (82.8%) achieved a sustained virological response. Among 987 participants completing treatment, 95.1% achieved a sustained virological response. In multivariable analysis, age > 40 years (adjusted odds ratio, aOR: 1.63; 95% confidence interval, CI: 1.04-2.54) and poor treatment adherence (aOR: 0.06; 95% CI: 0.02-0.20) were associated with sustained virological response. Of 34 serious adverse events during treatment, six led to treatment discontinuation including five non-treatment-related deaths. Conclusion: Community-based HCV treatment of people who use drugs in Thailand, within harm reduction settings, is safe and effective. Integration of this strategy into national programmes could enhance HCV elimination in people who use drugs.