ABSTRACT
Background: The lockdown during the COVID-19 pandemic had an strong impact on the management of patients with liver diseases in Spain We analyzed the impact of the lockdown period on PWID with ongoing high-risk practices attending an externalized hepatology outpatient clinic at the biggest harm reduction center (HRC) in Barcelona Methods: On site HCV point-of-care screening for HCV-IgG antibody and HCV-RNA (GenXpert®), liver stiffness measurement (LSM), antiviral therapy delivery and sustained virological response (SVR12) assessment were performed at the HRC Dried blood spot (DBS) was collected at baseline, SVR12 and every 6 months in order to differentiate relapse vs reinfection Adherence was assessed by daily or weekly visits The program included educative and harm-reduction interventions Results: Before the lockdown 845 individuals had been prospectively enrolled in the program Of these, 386 (46%) accepted HCV screening, of whom 212 (55%) were HCV-RNA positive Of the 149 (70%) individuals who already started treatment, median (P25-P75) age was 42 years (35-47), 86% were male, 45% foreigners, 33% homeless, 73% unemployed and 62% had been imprisoned before At enrolment, 72% injected daily (55% more than once a day) In regard to high risk practices, 30% reported either needle or paraphernalia sharing and 38% unprotected sexual relationships Baseline LSM values were 6 (4 9-7 6) kPa with 12% patients having advanced fibrosis (>9.5 kPa). All patients received pan-genotypic antiviral therapy either 8 or 12 weeks During Spain's lockdown period the center's attendance was reduced from 300 users/day to 70 users/day and the program recruitment rate from 6 6 to 1 3 individuals/day No patient initiated antiviral therapy during this period Overall 34 (28%) missed their follow-up visits during this period, including 4/10 patients under ongoing antiviral therapy The overall reinfection rate was 16/100 patients/year, 4(23%) happened after lockdown Although there was an increase in the use of drugs on the street/at home, 50% reduced the injection frequency during the lockdown period Conclusion: This patient-centered circuit demonstrates that HCV treatment can be successfully delivered to active PWID with high-risk practices However, the lockdown had a negative impact on loses to follow-up and also altered drug consumption habits, supporting the role of specific interventions.