Peer- and nurse-led outreach, financial incentives, and point-of-care testing to enhance testing and treatment for hepatitis C among people who have used drugs or experienced homelessness: The REACH_U Study

BACKGROUND: Strategies are needed to overcome barriers to hepatitis C virus (HCV) care in marginalised populations. This study evaluated an intervention integrating peer- and nurse-based outreach, financial incentives, point-of-care HCV antibody and RNA testing, and linkage to specialist assessment to increase testing and treatment initiation among people who have used drugs or experienced homelessness. METHODS: REACH_U is a historically controlled study comparing HCV RNA testing and treatment during a control phase consisting of referral to hospital-based testing and treatment (October 2018-March 2020) to an intervention phase to decentralise testing (April 2021-December 2024) in Lisbon, Portugal. During the control phase, point-of-care HCV antibody testing was performed with antibody-positive participants referred for hospital-based HCV RNA testing and treatment. During the intervention phase, a peer and nurse-based outreach team performed incentivised point-of-care HCV antibody and RNA testing in the community with referral to decentralised specialist assessment and treatment. Endpoints included the proportion receiving HCV RNA testing and initiating HCV therapy. RESULTS: Among 814 participants (control, n = 120; intervention, n = 694), mean age (42 vs. 45), proportion female (18% vs 24%), and homelessness (67% vs. 60%) were similar, but ever (51% vs 25%) and recent injecting drug use (48% vs 12%) was higher in the control. The proportion receiving HCV RNA testing (standard of care, 17 of 51; intervention, 135 of 148; 33% vs 91%, P < 0.001) and the proportion initiating treatment (standard of care, 4 of 15; intervention, 34 of 57; 27% vs 60%, P = 0.023) was higher in the intervention compared to the control phase. After adjusting for recent injecting drug use and current homelessness, the intervention phase was associated with greater odds of initiating treatment (aOR, 4.58; 95% CI 1.16-18.07). CONCLUSION: This decentralised model with linkage to a university hospital led to increased HCV RNA testing and treatment among people who have used drugs or experienced homelessness, providing a model that could be explored in other settings.