HCV-RNA viral load fingerstick assay to simplify screening and linkage to care of people who use drugs attending Italian addiction treatment centres: A pilot project

Background: People who use drugs (PWUDs) are the major drivers of HCV transmission in the world, representing the
target population for HCV screening and treatment. This prospective study aimed to evaluate the feasibility and the acceptability of HCV-RNA viral load fingerstick assay use to improve HCV screening and treatment among Italian PWUDs
attending different Italian Addiction Treatment Centres (Ser.D) in an outpatient setting. Methods: Between October
2020 and December 2021, the HCV screening was offered to 1258 consecutive PWUDs from 11 Addiction Treatment
Centres in 4 Regions of Northern, Central and Southern Italy. HCV analysis was carried out by means of a fingerstick
capillary whole blood RNA test. Results were given in 60 minutes. Results: 1453/1559 (93%) consecutive PWUDs were
enrolled. Patients were mostly male (1162/1453, 79%), with a mean age of 44.7 years ± 10.9 and a mean addiction treatment duration of 10.9 years ± 7. The main HCV risk factors identified were heroin addiction (1079/1453, 74%), a history
of injecting drug use (819/1453, 56%) and tattooing (906/1453, 62%). HCV RNA was identified in 286/1453 patients
(19.7%) participants. Among patients with detectable HCV RNA, 85.6% (245/286) were referred to specialists for HCV
treatment, and at the end of the study period, 58% (142/245) completed the treatment. All the treated patients achieved
SVR (Sustained Virologic Response). Conclusions: This is one of the largest HCV-RNA screening projects, highlighting
the feasibility and the acceptability of onsite testing performed with HCV-RNA viral load fingerstick assay in PWUDs
attending Ser.Ds. HCV screening and linkage to care remain worldwide far from comprehensive. The described easy-touse approach favours PWUD engagement and increases HCV treatment and elimination, as evidenced by the high rate
of completed treatments.