[Impact of outreach testing on elimination of hepatitis C].

Objectives: Analysis of changes in a group of patients with chronic hepatitis C (CHC) treated with direct-acting antivirals (DAAs) with a special focus on risk factors for transmission. Evaluation of cooperation with organizations working with people who inject drugs (PWID) including the impact of outreach testing.

Methods: A retrospective analysis and interannual comparison of CHC patients treated with DAAs at the Department of Infectious Diseases, University Hospital Brno, Czech Republic between 2018 and 2020.

Results: A total of 291 (101 in the year 2018, 111 in 2019 and 79 in 2020) patients with CHC have been treated. Comparison of results from the years 2018, 2019 and 2020 demonstrated a significant rise in the proportion of PWID (46.5 %, 64.9 % and 65.8 %, respectively). Also the proportion of genotype 3a infection (23.8 %, 30.6 % and 35.4 %) increased at the expense of genotype 1b infection (52.5 %, 46.9 % and 38.0 %). By contrast, the median age (43, 40 and 38 years) and the proportion of patients with liver cirrhosis decreased (20.8 %, 15.3 % and 12.7 %). The percentage of patients started on DAA therapy within one year of diagnosis increased (47.5 %, 53.2 % and 62.0 %). And so did the proportion of patients receiving therapy as a result of cooperation with organizations and facilities working with PWID (5.9 %, 25.2 % and 25.3 %). The downside was high numbers of patients lost to follow-up (19.8 %, 23.4 % and 22.3 %). Those were mostly patients who completed their therapy as planned and were only lost to after receiving the final dose of DAAs.

Conclusions: The fact that PWID have gradually become the dominant group of CHC patients is accompanied by a younger age of treated patients, a higher proportion of those with genotype 3a and less advanced liver damage. The changing spectrum of CHC patients makes medical professionals change their approach. Outreach testing and cooperation with organizations working with PWID have proved an effective way of improving the diagnosis and treatment of CHC.