ABSTRACT
Background: Elimination of Hepatitis C Virus (HCV) infection in individuals with substance use disorders (SUD) is key to achieve the WHO goal by 2030. However, HCV screening and treatment of these subjects is challenging . The aim of this study was to assess the level of attendance and the incidence of HCV infection during the COVID-19 pandemic in a cohort of subjects with SUD who had previously been screened in an addiction center. Methods: Prospective study conducted in an addiction center that included subjects with SUD, previously (2018-2019) screened for HCV, who were offered treatment by a multidisciplinary team in the addiction center. After 18 months, during the COVID-19 pandemic, they were offered HCV screening again to assess the incidence of new infections and reinfections. Results: In the first study, HCV screening was offered to 528 individuals with SUD but only 401 accepted. Of these, 112 (30%) were anti-HCV positive and 42 (10%) HCV-RNA positive and elegible for therapy. Direct-acting antivirals (DAAs) were started in 15 (24%) and all achieved sustained virological response. The main reason for non starting DAAs was loss of follow-up. After 18 months, only 242 (60%) of the 401 previously tested were still linked to the center and 176 (72%) agreed to be screened. Anti-HCV antibodies were detected in 58 (33%) and HCVRNA was detected in 6 (3.4%): 4 with known infection who had previously refused therapy and 2 (1.1%) new infections. Among those previously treated no case of HCV reinfection was detected.Attendance to the addiction center was lower in young subjects (44 ± 12 vs 47 ± 11, p=0.02) in those not receiving opiod substitution therapy (30% vs 70%, p=0.008) and among cocaine users (45% vs 55%, p=0.049). Previous psychiatric disorders were associated with higher linkage to the addiction center during follow-up (66% vs 34%, p=0.003). Conclusion: Despite a descentralized model of care, a high number of individulas with SUD do not accept HCV screening. The HCV prevalence and incidence of new infection is high in this population and the attendance to addiction centers low, with a 40% dropout rate. There are significant differences in terms of demographic, clinical and substance use variables between attending patients and those who abandon followup.