{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T08:30:43Z","timestamp":1765182643536,"version":"3.46.0"},"reference-count":21,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T00:00:00Z","timestamp":1764979200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Susan and Richard Levy Health Care Delivery Incubator"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>Background: People who inject drugs (PWID) have a higher risk of contracting hepatitis C (HCV) than the general population, but these individuals are often poorly served by traditional healthcare systems. The elimination of HCV as a threat to public health relies on the treatment of this population. Novel care models designed with input from PWID may help to better align care to the needs of PWID. Methods: We designed and implemented a community-based, point-of-care testing program for HCV delivered by a syringe service program, combined with facilitated access to a healthcare provider, care navigation, and financial incentives. We collected participant demographics and drug use patterns, testing and treatment history, and communication preferences. Descriptive analyses include the number of people tested between 15 October 2021 and 1 February 2025, their seropositivity rate, and the number who completed pre-treatment laboratory tests, completed treatment and achieved cure by sustained virologic response (SVR12) by 1 August 2025. Results: The program engaged 464 unique individuals, of whom 98 (21.1%) had a known diagnosis of HCV. Of 389 unique individuals who underwent point of care (POC) HCV antibody (Ab) testing, including 31 with a known prior diagnosis of HCV, 97 (24.9%) had a positive result. Of 439 unique individuals who underwent POC HIV Ab testing, only 1 had a positive result. Of 164 individuals with either a positive POC HCV Ab test or a known HCV diagnosis, 66 completed pre-treatment laboratory tests, identifying 52 viremic participants. Of those, 35 started and completed treatment. Among those who completed treatment, 9 (25.7%) achieved SVR12, 3 (8.6) failed to achieve SVR12, and 23 (65.7%) had outstanding laboratory orders for SVR12 determination. Conclusions: An incentivized, community-based, point-of-care testing program with facilitated linkage to care successfully engaged a high-risk population in HCV and HIV testing and treatment. However, substantial attrition occurred at each step of the care cascade, particularly at SVR12 determination. Additional strategies are needed to optimize retention throughout the entire care cascade.<\/jats:p>","DOI":"10.3390\/v17121589","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T08:21:43Z","timestamp":1765182103000},"page":"1589","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Getting to the Point: A Community-Designed, Low-Barrier Hepatitis C Testing and Treatment Program for People Who Inject Drugs in Rural America"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1121-4146","authenticated-orcid":false,"given":"Amanda N.","family":"Perry","sequence":"first","affiliation":[{"name":"The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Eccles","sequence":"additional","affiliation":[{"name":"Dartmouth Health, Section of Infectious Diseases and International Health, Lebanon, NH 03756, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1342-5863","authenticated-orcid":false,"given":"Shoshana H.","family":"Bardach","sequence":"additional","affiliation":[{"name":"The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alastair","family":"Huntley","sequence":"additional","affiliation":[{"name":"The HIV\/HCV Resource Center, Lebanon, NH 03766, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7031-2480","authenticated-orcid":false,"given":"Ryan","family":"Fowler","sequence":"additional","affiliation":[{"name":"The HIV\/HCV Resource Center, Lebanon, NH 03766, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7987-7168","authenticated-orcid":false,"given":"David","family":"de Gijsel","sequence":"additional","affiliation":[{"name":"The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA"},{"name":"Dartmouth Health, Section of Infectious Diseases and International Health, Lebanon, NH 03756, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/j.drugalcdep.2018.03.049","article-title":"Injection drug use, HIV\/HCV, and related services in nonurban areas of the United States: A systematic review","volume":"188","author":"Paquette","year":"2018","journal-title":"Drug Alcohol Depend."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e659","DOI":"10.1016\/S2214-109X(23)00057-8","article-title":"Epidemiology of injecting drug use, prevalence of injecting-related harm, and exposure to behavioural and environmental risks among people who inject drugs: A systematic review","volume":"11","author":"Degenhardt","year":"2023","journal-title":"Lancet Glob. Health"},{"key":"ref_3","unstructured":"World Health Organization (2022, October 18). Elimination of Hepatitis by 2030. Available online: https:\/\/www.who.int\/health-topics\/hepatitis\/elimination-of-hepatitis-by-2030#tab=tab_1."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"12722","DOI":"10.3748\/wjg.v20.i36.12722","article-title":"Eligibility of persons who inject drugs for treatment of hepatitis C virus infection","volume":"20","author":"Arain","year":"2014","journal-title":"World J. Gastroenterol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1016\/j.drugalcdep.2006.10.014","article-title":"Stigma, discrimination and the health of illicit drug users","volume":"88","author":"Ahern","year":"2007","journal-title":"Drug Alcohol Depend."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1007\/s11904-018-0393-0","article-title":"Challenges Facing a Rural Opioid Epidemic: Treatment and Prevention of HIV and Hepatitis C","volume":"15","author":"Schranz","year":"2018","journal-title":"Curr. HIV\/AIDS Rep."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e47395","DOI":"10.2196\/47395","article-title":"Coproduction of Low-Barrier Hepatitis C Virus and HIV Care for People Who Use Drugs in a Rural Community: Brief Qualitative Report","volume":"15","author":"Bardach","year":"2023","journal-title":"J. Particip. Med."},{"key":"ref_8","first-page":"e76","article-title":"Availability of HIV and HCV On-Site Testing and Treatment at Syringe Service Programs in the United States","volume":"79","author":"Behrends","year":"2018","journal-title":"JAIDS"},{"key":"ref_9","unstructured":"American Association for the Study of Liver Diseases, and Infectious Diseases Society of America (2024, June 26). HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C. Simplified HCV Treatment for Treatment-Naive Adults Without Cirrhosis. Available online: https:\/\/www.hcvguidelines.org\/."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1111\/jvh.13437","article-title":"Hepatitis C testing and treatment uptake among young people who use opioids in New York City: A cross-sectional study","volume":"28","author":"Kapadia","year":"2021","journal-title":"J. Viral Hepat."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2407","DOI":"10.1111\/liv.14634","article-title":"Hepatitis C treatment uptake among people who inject drugs in the oral direct-acting antiviral era","volume":"40","author":"Gicquelais","year":"2020","journal-title":"Liver Int."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2104","DOI":"10.1111\/add.14698","article-title":"Enhancing engagement in hepatitis C care among people who inject drugs","volume":"114","author":"Marshall","year":"2019","journal-title":"Addiction"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1080\/14659891.2019.1704076","article-title":"Engagement in the Hepatitis C care continuum among people who use drugs","volume":"25","author":"Tofighi","year":"2020","journal-title":"J. Subst. Use"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1001\/jamainternmed.2022.0170","article-title":"Accessible Hepatitis C Care for People Who Inject Drugs: A Randomized Clinical Trial","volume":"182","author":"Eckhardt","year":"2022","journal-title":"JAMA Intern. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/S2468-1253(22)00346-6","article-title":"Impact of hepatitis C virus point-of-care RNA viral load testing compared with laboratory-based testing on uptake of RNA testing and treatment, and turnaround times: A systematic review and meta-analysis","volume":"8","author":"Trickey","year":"2023","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"103982","DOI":"10.1016\/j.drugpo.2023.103982","article-title":"Single-visit hepatitis C point-of-care testing, linkage to nursing care, and peer-supported treatment among people with recent injecting drug use at a peer-led needle and syringe program: The TEMPO Pilot Study","volume":"114","author":"Grebely","year":"2023","journal-title":"Int. J. Drug Policy"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1186\/s12954-023-00801-1","article-title":"Real-world hepatitis C treatment outcomes and reinfections among people who inject drugs at a needle and syringe program in Stockholm, Sweden","volume":"20","author":"Lindqvist","year":"2023","journal-title":"Harm Reduct. J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1177\/1745691612447309","article-title":"Self-Determination Theory Applied to Health Contexts: A Meta-Analysis","volume":"7","author":"Ng","year":"2012","journal-title":"Perspect. Psychol. Sci."},{"key":"ref_19","first-page":"100490","article-title":"Rapid hepatitis C virus point-of-care RNA testing and treatment at an integrated supervised consumption service in Toronto, Canada: A prospective, observational cohort study","volume":"22","author":"Lettner","year":"2023","journal-title":"Lancet Reg. Health Am."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1235","DOI":"10.1093\/cid\/ciad503","article-title":"The Urgent Need to Implement Point-of-Care RNA Testing for Hepatitis C Virus to Support Elimination","volume":"78","author":"Kapadia","year":"2024","journal-title":"Clin. Infect. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1007\/s10461-023-04249-z","article-title":"Long-Term Effects of Incentives for HIV Viral Suppression: A Randomized Clinical Trial","volume":"28","author":"Novak","year":"2024","journal-title":"AIDS Behav."}],"container-title":["Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4915\/17\/12\/1589\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T08:27:27Z","timestamp":1765182447000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4915\/17\/12\/1589"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,6]]},"references-count":21,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["v17121589"],"URL":"https:\/\/doi.org\/10.3390\/v17121589","relation":{},"ISSN":["1999-4915"],"issn-type":[{"value":"1999-4915","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,6]]}}}