CUTTS HepC: Catalysing uptake of under-utilised tools & treatment simplification for HepC

Objective

The overall objective of the CUTTS HepC Project is to generate evidence that supports efforts to reach people who inject drugs by embedding hepatitis C testing and treatment services within harm reduction programs and piloting the use of two novel/underused products aimed at reducing risks associated with injecting drugs. This Project will be implemented by the Médecins du Monde-led Consortium in Georgia, Armenia and Tanzania.

The implementation of a novel hepatitis C model of care aims to provide a simplified testing and treatment pathway, by trialling a novel diagnostic test and rapid treatment initiation. The aim of this study is to increase access to and retention within hepatitis C testing and treatment pathways, by reducing the cost of diagnosis and the burden of attending multiple appointments.

The low-dead space syringe (LDSS) study seeks to generate real-world evidence from low- and middle-income countries on values and preferences for LDSS, actual uptake and use when offered preferred options, and to determine the impact of LDSS on reducing the risk of acquiring HIV and hepatitis C.

The trial of long-acting depot buprenorphine in Tanzania will assess the feasibility, acceptability, effectiveness and cost-effectiveness of this intervention for people who inject drugs.

The evidence generated from this work will be used to inform country-specific and global policies and guidelines, and to support market-shaping efforts through demand-creation and negotiated price-reductions.

Timeline

2023–2027.

Approach

The hepatitis C model of care study will assess the accuracy of the shortened read-time of existing rapid hepatitis C antibody tests for identifying those with current hepatitis C infection, trialling the rapid initiation of hepatitis C treatment (“same-day”), and explore the role of pooled RNA testing for monitoring achieving cure and re-infection. The study will generate evidence on the feasibility, utility, effectiveness and acceptability of these interventions.

The LDSS study will include a strong community-led values and preferences component led by INPUD that will feed into a broad distribution of preferred LDSS option/s at selected sites.

Data on the actual use of LDSS when made available and HIV and hepatitis C incident infections will also be collected. This data will be used to inform the growing global evidence base to support the effective implementation of LDSS as an additional harm reduction tool for reducing injecting-related harms and blood-borne virus acquisition.

The long-acting depot buprenorphine trial will assess the values and preferences of people who inject drugs and assess the feasibility, acceptability, and effectiveness of this intervention. This data will feed into mathematical modelling on the cost-effectiveness of this intervention to support market-shaping efforts.

Community impact

The CUTTS HepC Project will directly benefit those enrolled in the studies who may not otherwise have access to these interventions and will generate evidence to support increased access to these interventions after the completion of the project.

The evidence generated from this Project will be used to inform country-specific and global policies.