I have MS in Epidemiology from State University of New York. I have been working in HIV prevention among people who inject drugs in Ukraine since 2007, currently work for the Alliance for Public Health, Kyiv, Ukraine, in a project on HCV prevention and treatment among PWID in low-resource countries.

Issue
PWID bear the highest burden of HCV and due to multiple barriers suffer from suboptimal access to accessing treatment. There is insufficient evidence on HCV integration in harm reduction from low-middle income countries, where the burden of HCV among PWID is the most significant. This study seeks to contribute evidence to the global efforts in combating HCV among PWID, by identifying effective strategies to overcome barriers to testing and treatment, and advancing the goals of the WHO's global hepatitis strategy to eliminate HCV. The aim to assess acceptability and effectiveness of integrating HCV testing and treatment within community-based harm reduction programs for PWID in low-resource countries and identify key factors and implementation options associated with improved outcomes.

Setting
Study is implemented at harm reduction sites in Egypt, Kyrgyzstan, and Nigeria where HCV prevalence in PWID reaches 20, 50, and 10% respectively.

Project
The study is implemented within Innovate, Involve, Inspire Project and will test a Community-based Simplified HCV Testing and Treatment Algorithm (CBSA), implemented at community harm reduction sites. All participants with positive anti-HCV test will undergo diagnostics including HCV-RNA testing at community. Those eligible for CBSA will be prescribed a combination tablet: sofosbuvir/daclatasvir. Sustained virologic response (SVR) will be assessed 12 weeks after treatment completion. Those achieving SVR will be tested for HCV_RNA at 6 and 12 months after SVR12. Expected sample size is 1454 PWID with confirmed HCV diagnosis. Recruitment of study participants starts in January 2025.

Outcome
Primary outcomes are based on HCV treatment cascade:(a)Completing the pretreatment evaluation;(b)Initiating and completing the full DAA course;(c)Achieving SVR12;(d)Re-infection rate at six and 12 months after SVR12. Secondary outcomes include treatment motivation, adherence, quality of life, and treatment satisfaction. The qualitative component will explore client-level, provider-level, organizational, community-level, and structural factors influencing the integration of CBSA into harm reduction programs.