Towards elimination of HCV infection in undocumented migrants and low-income refugees: a prospective intervention study in Italy

Abstract

Abstract Background: Migrants, mainly undocumented and low-income refugees, are at high risk of HCV infection, but are a difficult-to-reach and to-treat population. The aim of the study was to identify a elimination model for HCV infection in these undocumented migrants and low-income refugees living southern Italy. Methods: a prospective, multicenter, collaborative study based on a four-phase-program (educational counseling, screening, linkage-to-care and treatment) was designed. After educational counseling on parenteral infections, anonymous HCV screening was offered to all undocumented imigrants and low-income refugees observed at one of the 1st level clinical centers. The HCV-RNA-positive subjects were referred to one of the 3rd level units of Infectious Diseases (ID) and treated with a 12-week course of sofosbuvir-velpatasvir and observed for 12 weeks after the end of DAA treatment. Results: Of the 3,501 migrants observed in the study period, 3,417 (97.6%) agreed to be screened; 185 (4.7%) were anti-HCV-positive and, of these, 53 (28.6%) were HCV-RNA-positive. Of these 53 subjects, 48 (90.5%) were referred to an ID unit and started DAA treatment. Of these 48 subjects, 47 (97.9%) showed a sustained virological response and one dropped-out in follow-up after DAA treatment. No subject had any adverse event. Conclusions: This model seems effective to eliminate HCV infection in a difficult-to-reach and to-treat population, such as undocumented migrants and low-income refugees