Year 2026 / Volume 118 / Number 3
Original
Results of a hepatitis C microelimination project in an addiction treatment center

148-155

DOI: 10.17235/reed.2025.11495/2025

Elisa Rodríguez-Seguel, Ricardo Ruiz Pérez, Enrique Pérez-Godoy Díaz, María del Carmen Lozano Domínguez, Álvaro Giráldez Gallego, Trinidad Desongles Corrales, María Teresa Ferrer Ríos, José Manuel Sousa Martín, Juan Manuel Pascasio Acevedo,

Abstract
Background: patients on opioid substitution therapy constitute a group with a high burden of hepatitis C and candidates for interventions aimed at microelimination. Aims: to analyze the baseline prevalence of both previous contact and/or active infection, measure the response to current treatment provided through a simplified circuit and estimate the impact of this intervention on the reduction of the proportion of the viremic population. Methods: people affiliated to an addiction treatment center underwent an in situ diagnostic sequence using saliva serological screening and viremia quantification with a dry blood spot test. Viremic patients were linked to care and treatment, which was administered in the first single appointment with pan-genotypic direct-acting antivirals. The McNemar test was used to compare the proportion of active infection before and after intervention. Results: with a participation rate of 99.2 %, the seroprevalence for hepatitis C was 44.6 % (115/258) while active infection was present in 20.9 % of seropositive individuals (24/115). The response rate to treatment was 54.2 % by intention-to-treat and 61.9 % by per-protocol analysis. Successful treatment of 13 patients resulted in an estimated global reduction of the active infection rate from 9.3 % to 4.3 % (p = 0.0002), for a theorical scenario with no reinfections. By adjusting for the known reinfection rates, the prevalence of active infection also decreased to 4.2 % for individuals without assumed recent drug use (p = 0.0074), but no changes were found for estimates in patients with a supposed recent drug use (p = 0.2632). Conclusions: focused efforts targeted to this high-risk group, including both screening and treatment initiatives, can potentially reduce the prevalence of active hepatitis C infections.
Lay Summary
Microelimination of hepatitis C in vulnerable populations constitutes a challenging public health topic. This pragmatic initiative, designed for patients on opioid substitution therapy, provides valuable operational information on the current rate of viremic patients, which is close to 10%. Screening conducted using the addiction treatment center as the point of care, by simple tools, led to almost universal participation. This sequential diagnostic model (saliva test and dry blood spot samples), which did not involve venipuncture sampling, is feasible and potentially adaptable to similar populations. However, traditional linkage to hospital-based care was associated with considerable loss to follow-up, which limited response rates by intention to treat, occurring in slightly more than half of cases. The potential reinfections described in this population could also compromise the project's impact, especially in patients with recent drug use. Decentralizing treatment and further efforts to extend the observation period could provide more robust empirical support for these strategies.
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Rodríguez-Seguel E, Ruiz Pérez R, Pérez-Godoy Díaz E, Lozano Domínguez M, Giráldez Gallego Á, Desongles Corrales T, et all. Results of a hepatitis C microelimination project in an addiction treatment center . 11495/2025


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Publication history

Received: 14/07/2025

Accepted: 04/08/2025

Online First: 29/09/2025

Published: 06/03/2026

Article Online First time: 77 days

Article editing time: 235 days


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