A model to eradicate HCV in undocumented migrants and low-income refugees in Italy

ABSTRACT

Background and aims: To validate an innovative eradication model for HCV infection in undocumented migrants and low-income refugees living Southern Italy. Method: a prospective, multicenter, collaborative study was started in June 2018 with The studywas stopped in February 2020 due to the outbreak of SARS-CoV-2 infection in Italy and was resumed in February 2021. At the six 1st level centers participating to the study volunteer associations that deal with the first needs of disadvantaged people performed the enrolment and the screening for anti-HCV, HBsAg and anti-HIV;epidemiological data were collected in an electronic database. Anti-HCV-positive subjects were sent to two 3rd level centers for the clinical, virological and therapeutic evaluation. For the HCV-RNA-positive subjects HCV genotyping and a clinical, biochemical and ultrasound staging was performed. The HCV RNApositive subjects have been treated with sofosbuvir-velpatasvir for 12 weeks and followed for 12 months from the end of therapy. Results: Of the 3, 991 migrants observed in the study period, 3, 897 (97.6%) accepted to be screened. They were young (median age 26 years), predominantly male (85.9%) and came from North Africa (3.8%), from Sub-Saharan Africa (68.4%), from Eastern Europe (8.1%), from Indo-Pakistan (17%) and from other countries (2.7%). Of the 3, 897 enrolled subjects, 185 (4.7%) resulted anti-HCV positive. The Figure shows the HCV-cure cascade. All the 185 anti-HCV-positive subjects were linked to care at 3rdID and tested for HCV RNA and 53 (28.6%) resulted HCV-RNA positive. Of these, 46 (86.8%) started DAA regimen with sofosbuvir plus velpatasvir (15 with GT 1b, 10 with 1a, 16 with 3, 3 with 4 and 2 with 2). Forty-two completed the follow-up and 4 was still pending. Of these 42 subjects, 41 (97.6%) showed a SVR12 and SVR 24, and one dropped-out in follow-up after the stop of DAA treatment. No subject had adverse event. (Figure Presented) Conclusion: This model seems to be effective to eradicate HCV infection among a difficult-to-manage population, such as undocumented migrants and low-income refugees