{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T02:42:38Z","timestamp":1790649758372,"version":"4.1.0"},"update-to":[{"DOI":"10.1371\/journal.pmed.1003653","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2021,6,15]],"date-time":"2021-06-15T00:00:00Z","timestamp":1623715200000}}],"reference-count":36,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2021,6,1]],"date-time":"2021-06-01T00:00:00Z","timestamp":1622505600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005416","name":"Norges Forskningsr\u00e5d","doi-asserted-by":"publisher","award":["269855"],"award-info":[{"award-number":["269855"]}],"id":[{"id":"10.13039\/501100005416","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Helse Vest Regionalt Helsef\u00f8retak","award":["\u00c5pen prosjektst\u00f8tte"],"award-info":[{"award-number":["\u00c5pen prosjektst\u00f8tte"]}]}],"content-domain":{"domain":["www.plosmedicine.org"],"crossmark-restriction":false},"short-container-title":["PLoS Med"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>The standard pathways of testing and treatment for hepatitis C virus (HCV) infection in tertiary healthcare are not easily accessed by people who inject drugs (PWID). The aim of this study was to evaluate the efficacy of integrated treatment of chronic HCV infection among PWID.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods and findings<\/jats:title>\n<jats:p>INTRO-HCV is a multicenter, randomized controlled clinical trial. Participants recruited from opioid agonist therapy (OAT) and community care clinics in Norway over 2017 to 2019 were randomly 1:1 assigned to the 2 treatment approaches. Integrated treatment was delivered by multidisciplinary teams at opioid agonist treatment clinics or community care centers (CCCs) for people with substance use disorders. This included on-site testing for HCV, liver fibrosis assessment, counseling, treatment, and posttreatment follow-up. Standard treatment was delivered in hospital outpatient clinics. Oral direct-acting antiviral (DAA) medications were administered in both arms. The study was not completely blinded. The primary outcomes were time-to-treatment initiation and sustained virologic response (SVR), defined as undetectable HCV RNA 12 weeks after treatment completion, analyzed with intention to treat, and presented as hazard ratio (HR) and odds ratio (OR) with 95% confidence intervals.<\/jats:p>\n<jats:p>Among 298 included participants, 150 were randomized to standard treatment, of which 116\/150 (77%) initiated treatment, with 108\/150 (72%) initiating within 1 year of referral. Among those 148 randomized to integrated care, 145\/148 (98%) initiated treatment, with 141\/148 (95%) initiating within 1 year of referral. The HR for the time to initiating treatment in the integrated arm was 2.2 (1.7 to 2.9) compared to standard treatment. SVR was confirmed in 123 (85% of initiated\/83% of all) for integrated treatment compared to 96 (83% of initiated\/64% of all) for the standard treatment (OR among treated: 1.5 [0.8 to 2.9], among all: 2.8 [1.6 to 4.8]). No severe adverse events were linked to the treatment.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Integrated treatment for HCV in PWID was superior to standard treatment in terms of time-to-treatment initiation, and subsequently, more people achieved SVR. Among those who initiated treatment, the SVR rates were comparable. Scaling up of integrated treatment models could be an important tool for elimination of HCV.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Trial registration<\/jats:title>\n<jats:p>ClinicalTrials.gov.no <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT03155906\" xlink:type=\"simple\">NCT03155906<\/jats:ext-link><\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pmed.1003653","type":"journal-article","created":{"date-parts":[[2021,6,1]],"date-time":"2021-06-01T20:35:33Z","timestamp":1622579733000},"page":"e1003653","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmed.corrections_policy","source":"Crossref","is-referenced-by-count":67,"title":["Integrated treatment of hepatitis C virus infection among people who inject drugs: A multicenter randomized controlled trial (INTRO-HCV)"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8757-2092","authenticated-orcid":true,"given":"Lars T.","family":"Fadnes","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6469-9354","authenticated-orcid":true,"given":"Christer Frode","family":"Aas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8701-7638","authenticated-orcid":true,"given":"J\u00f8rn Henrik","family":"Vold","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4750-5861","authenticated-orcid":true,"given":"Rafael Alexander","family":"Leiva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Ohldieck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatemeh","family":"Chalabianloo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7525-9701","authenticated-orcid":true,"given":"Svetlana","family":"Skurtveit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ole J\u00f8rgen","family":"Lygren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olav","family":"Dalg\u00e5rd","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8291-5890","authenticated-orcid":true,"given":"Peter","family":"Vickerman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5043-5107","authenticated-orcid":true,"given":"H\u00e5vard","family":"Midgard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4243-5067","authenticated-orcid":true,"given":"Else-Marie","family":"L\u00f8berg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8912-8710","authenticated-orcid":true,"given":"Kjell Arne","family":"Johansson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the INTRO-HCV Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,6,1]]},"reference":[{"key":"pmed.1003653.ref001","unstructured":"Institute for Health Metrics and Evaluation (IHME). University of Washington. Global burden of disease (GBD) compare from Institute for Health Metrics and Evaluation (IHME). Seattle, WA [cited 2020 Aug 13]. http:\/\/vizhub.healthdata.org\/gbd-compare."},{"issue":"12","key":"pmed.1003653.ref002","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.1016\/S1473-3099(16)30325-5","article-title":"Estimating the burden of disease attributable to injecting drug use as a risk factor for HIV, hepatitis C, and hepatitis B: findings from the Global Burden of Disease Study 2013","volume":"16","author":"L Degenhardt","year":"2016","journal-title":"Lancet Infect Dis"},{"issue":"6","key":"pmed.1003653.ref003","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1016\/S2468-1253(19)30085-8","article-title":"The contribution of injection drug use to hepatitis C virus transmission globally, regionally, and at country level: a modelling study","volume":"4","author":"A Trickey","year":"2019","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"pmed.1003653.ref004","unstructured":"World Health Organization (WHO). Guidelines for the screening, care and treatment of persons with chronic hepatitis C infection. Geneva, Switzerland: 2016 April 2016. Report No.: ISBN: 978 92 4 154961 5."},{"issue":"1","key":"pmed.1003653.ref005","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1111\/add.14393","article-title":"Global, regional, and country-level estimates of hepatitis C infection among people who have recently injected drugs","volume":"114","author":"J Grebely","year":"2019","journal-title":"Addiction"},{"issue":"5 Suppl 1","key":"pmed.1003653.ref006","first-page":"S35","article-title":"Natural history of chronic hepatitis C","volume":"36","author":"LB Seeff","year":"2002","journal-title":"Hepatology"},{"issue":"9","key":"pmed.1003653.ref007","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1038\/nrgastro.2013.107","article-title":"Epidemiology and natural history of HCV infection","volume":"10","author":"B Hajarizadeh","year":"2013","journal-title":"Nat Rev Gastroenterol Hepatol"},{"issue":"2","key":"pmed.1003653.ref008","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1016\/j.jhep.2013.09.022","article-title":"Liver fibrosis progression at autopsy in injecting drug users infected by hepatitis C: A longitudinal long-term cohort study","volume":"60","author":"KB Kielland","year":"2014","journal-title":"J Hepatol"},{"issue":"1","key":"pmed.1003653.ref009","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.jhep.2012.08.024","article-title":"All-cause and liver-related mortality in hepatitis C infected drug users followed for 33 years: a controlled study","volume":"58","author":"KB Kielland","year":"2013","journal-title":"J Hepatol"},{"key":"pmed.1003653.ref010","unstructured":"Waal H, Bussesund K, Clausen T, Skeie I, H\u00e5seth A, Lillevold PH. RAPPORT 1\/2016: Statusrapport 2015. Mot grensene for vekst og nytte? Universitetet i Oslo, Oslo Universitetssykehus, Senter for rus- og avhengighetsforskning (SERAF). 2016."},{"issue":"1 Suppl","key":"pmed.1003653.ref011","doi-asserted-by":"crossref","first-page":"S33","DOI":"10.1016\/j.jhep.2016.07.012","article-title":"HCV epidemiology in high-risk groups and the risk of reinfection","volume":"65","author":"H Midgard","year":"2016","journal-title":"J Hepatol"},{"issue":"4","key":"pmed.1003653.ref012","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1016\/j.jhep.2019.11.012","article-title":"Hepatitis C reinfection after successful antiviral treatment among people who inject drugs: A meta-analysis","volume":"72","author":"B Hajarizadeh","year":"2020","journal-title":"J Hepatol"},{"issue":"11","key":"pmed.1003653.ref013","doi-asserted-by":"crossref","first-page":"e0166451","DOI":"10.1371\/journal.pone.0166451","article-title":"Hepatitis C Treatment Uptake among Patients Who Have Received Opioid Substitution Treatment: A Population-Based Study","volume":"11","author":"H Midgard","year":"2016","journal-title":"PLoS ONE"},{"issue":"8","key":"pmed.1003653.ref014","doi-asserted-by":"crossref","first-page":"1400","DOI":"10.1111\/liv.14043","article-title":"Disparities in uptake of direct-acting antiviral therapy for hepatitis C among people who inject drugs in a Canadian setting","volume":"39","author":"ME Socias","year":"2019","journal-title":"Liver Int"},{"key":"pmed.1003653.ref015","unstructured":"World Hepatitis Summit in S\u00e3o Paulo (Brazil). S\u00e3o Paulo Declaration on Viral Hepatitis from World Hepatitis Summit 1\u20133. World health Organization, 2017. November 2017:3."},{"key":"pmed.1003653.ref016","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.2147\/PPA.S49113","article-title":"Factors associated with uptake, adherence, and efficacy of hepatitis C treatment in people who inject drugs: a literature review","volume":"7","author":"V Mravcik","year":"2013","journal-title":"Patient Prefer Adherence"},{"issue":"3","key":"pmed.1003653.ref017","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1111\/jvh.12129","article-title":"Uptake of hepatitis C treatment among people who inject drugs attending Needle and Syringe Programs in Australia, 1999\u20132011","volume":"21","author":"J Iversen","year":"2014","journal-title":"J Viral Hepat"},{"issue":"1","key":"pmed.1003653.ref018","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1097\/MEG.0b013e328340c451","article-title":"Hepatitis C testing and treatment among active drug users in Amsterdam: results from the DUTCH-C project","volume":"23","author":"CE Lindenburg","year":"2011","journal-title":"Eur J Gastroenterol Hepatol"},{"key":"pmed.1003653.ref019","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.drugpo.2017.05.019","article-title":"Research priorities to achieve universal access to hepatitis C prevention, management and direct-acting antiviral treatment among people who inject drugs","volume":"47","author":"J Grebely","year":"2017","journal-title":"Int J Drug Policy"},{"key":"pmed.1003653.ref020","article-title":"Integrated care of severe infectious diseases to people with substance use disorders; a systematic review","author":"JH Vold","year":"2019","journal-title":"BMC Infect Dis"},{"key":"pmed.1003653.ref021","article-title":"Screening for Hepatitis C Virus Infection in Adolescents and Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force","author":"R Chou","year":"2020","journal-title":"JAMA"},{"key":"pmed.1003653.ref022","unstructured":"Hjellum K, W\u00e5de-Engelsen M. BrukerPlan 2015: En kartlegging av kommunale tjenestemottakere over 18 \u00e5r med psykiske problem, rusrelaterte problem, eller samtidige rus- og psykiske problem (ROP). Bergen kommune, 2016."},{"issue":"1","key":"pmed.1003653.ref023","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1186\/s12879-019-4598-7","article-title":"Integrated treatment of hepatitis C virus infection among people who inject drugs: study protocol for a randomised controlled trial (INTRO-HCV)","volume":"19","author":"LT Fadnes","year":"2019","journal-title":"BMC Infect Dis"},{"key":"pmed.1003653.ref024","article-title":"Dispensations of benzodiazepines, z-hypnotics, and gabapentinoids to patients receiving opioid agonist therapy; a prospective cohort study in Norway from 2013 to 2017","author":"JH Vold","year":"2020","journal-title":"BMC Health Serv Res"},{"issue":"1","key":"pmed.1003653.ref025","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1186\/s13011-020-00286-2","article-title":"Uptake and predictors of direct-acting antiviral treatment for hepatitis C among people receiving opioid agonist therapy in Sweden and Norway: a drug utilization study from 2014 to 2017","volume":"15","author":"CF Aas","year":"2020","journal-title":"Subst Abuse Treat Prev Policy"},{"issue":"1","key":"pmed.1003653.ref026","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1186\/s12916-018-1038-2","article-title":"Real-world evidence: How pragmatic are randomized controlled trials labeled as pragmatic?","volume":"16","author":"R Dal-Re","year":"2018","journal-title":"BMC Med"},{"issue":"11","key":"pmed.1003653.ref027","doi-asserted-by":"crossref","first-page":"807","DOI":"10.7326\/0003-4819-158-11-201306040-00005","article-title":"Blood tests to diagnose fibrosis or cirrhosis in patients with chronic hepatitis C virus infection: a systematic review","volume":"158","author":"R Chou","year":"2013","journal-title":"Ann Intern Med"},{"issue":"3","key":"pmed.1003653.ref028","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1002\/hep.24105","article-title":"Performance of the aspartate aminotransferase-to-platelet ratio index for the staging of hepatitis C-related fibrosis: an updated meta-analysis","volume":"53","author":"ZH Lin","year":"2011","journal-title":"Hepatology"},{"issue":"3","key":"pmed.1003653.ref029","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1053\/jhep.2002.31250","article-title":"Hepatic encephalopathy\u2014definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998","volume":"35","author":"P Ferenci","year":"2002","journal-title":"Hepatology"},{"issue":"9263","key":"pmed.1003653.ref030","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1016\/S0140-6736(00)04337-3","article-title":"The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials","volume":"357","author":"D Moher","year":"2001","journal-title":"Lancet"},{"key":"pmed.1003653.ref031","unstructured":"EAEMP. European Agency for Evaluation of Medical products. Guidelines for clinical practice. Including errata. 2002."},{"key":"pmed.1003653.ref032","unstructured":"OECD. List of OECD series on principles on good laboratory practice and compliance monitoring (documents 1 to 13). 1998."},{"issue":"9","key":"pmed.1003653.ref033","doi-asserted-by":"crossref","first-page":"594","DOI":"10.7326\/M18-1715","article-title":"Intensive Models of Hepatitis C Care for People Who Inject Drugs Receiving Opioid Agonist Therapy: A Randomized Controlled Trial","volume":"170","author":"MJ Akiyama","year":"2019","journal-title":"Ann Intern Med"},{"issue":"9","key":"pmed.1003653.ref034","doi-asserted-by":"crossref","first-page":"1900","DOI":"10.1093\/cid\/ciz546","article-title":"Outcomes of Treatment for Hepatitis C in Primary Care, Compared to Hospital-based Care: A Randomized, Controlled Trial in People Who Inject Drugs","volume":"70","author":"AJ Wade","year":"2020","journal-title":"Clin Infect Dis"},{"key":"pmed.1003653.ref035","article-title":"Elbasvir-Grazoprevir to Treat Hepatitis C Virus Infection in Persons Receiving Opioid Agonist Therapy: A Randomized Trial","author":"GJ Dore","year":"2016","journal-title":"Ann Intern Med"},{"issue":"1","key":"pmed.1003653.ref036","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.jhep.2019.09.022","article-title":"Integrating HCV testing with HIV programs improves hepatitis C outcomes in people who inject drugs: A cluster-randomized trial","volume":"72","author":"SS Solomon","year":"2020","journal-title":"J Hepatol"}],"updated-by":[{"DOI":"10.1371\/journal.pmed.1003653","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2021,6,15]],"date-time":"2021-06-15T00:00:00Z","timestamp":1623715200000}}],"container-title":["PLOS Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pmed.1003653","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,6,15]],"date-time":"2021-06-15T17:39:14Z","timestamp":1623778754000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pmed.1003653"}},"subtitle":[],"editor":[{"given":"Mirjam E. 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