Integrated hepatitis C treatment for patients with injecting drug dependence (INTRO-HCV)

In 2017, when the project began, more than half of the patients receiving medication-assisted rehabilitation (MAR) in Norway had a chronic infection with the hepatitis C virus (HCV). Chronic hepatitis C poses a high risk of severe complications such as liver failure and death within a few decades. Although effective treatment for hepatitis C exists, only one-third of those with chronic hepatitis C had received treatment for it when we started in 2017. To address the challenges of hepatitis C, we formed a group to establish a new integrated treatment model. Our hypothesis was that an integrated treatment model could reach significantly more individuals than standard treatment. The integrated treatment model involved starting treatment concurrently with other support for substance use disorders, using a simplified model that required less blood sampling, minimal travel time, familiar healthcare personnel, and coordination with other treatments to make follow-up as straightforward as possible. We initiated this in both Bergen and Stavanger. We tested this with a randomised study involving 298 individuals, where half received integrated treatment and the other half received standard treatment—all with modern direct-acting medications. The results aligned well with our hypotheses. Among those who received integrated treatment, 98% commenced treatment for hepatitis C, while 77% started among those who received standard treatment. On average, treatment began over twice as quickly for those receiving integrated treatment. Furthermore, we observed that 93% of those offered integrated treatment and tested became virus-free (cured of hepatitis C) compared to 73% of those who received standard treatment. There were no serious events deemed related to the treatment. We found that the integrated treatment was effective for both women and men, among those receiving medication-assisted rehabilitation and those receiving municipal services, among the youngest and oldest individuals with substance dependence, both for those with stable and unstable housing situations, and among those who continued to inject substances. Such a treatment model significantly improves the prospects for eliminating hepatitis C—locally, nationally, and globally. The results of the study were published, among other places, in the esteemed journal PLOS Medicine and have since contributed to influencing international practice, with integrated treatment becoming part of the recommendations in an increasing number of locations. In connection with the study, two PhD degrees have also been completed by Christer Aas and Jørn Henrik Vold, both of whom defended their theses in June 2021.