DIFERENCIAS EN EL ACCESO Y EN EL TIEMPO HASTA EL INICIO DE TRATAMIENTO HEPATITIS C EN PERSONAS CON DESORDENES DE SALUD MENTAL

People who inject drugs (PWID) and other marginalized populations with high hepatitis C virus (HCV) infection rates represent a unique challenge for treatment initiation due to health, administrative and social barriers. We analyzed the HCV cascade of care (CoC) in some vulnerable subpopulations in Madrid, Spain, when using a mobile point of care. to identify gaps and barriers to improve HCV elimination efforts in these populations. Methods: From 2019 to 2021, a mobile unit was used to screen for HCV using a linkage-to-care and two-step point-of-care-based strategy. Viremic participants were grouped into four subgroups: PWID, homeless individuals, people with a mental health disorder (MHD) and people with alcohol use disorder (AUD). Logistic regression and Cox and Aalen’s additive models were used to analyze associated factors and differences between groups. Results: A prospectively recruited cohort of 214 HCV infected individuals (73 PWID, 141 homeless, 57 with a MHD and 91 with AUD) participated in the study. The overall HCV CoC analysis found that: 178 (83.1%) attended a hospital, 164 (76.6%) initiated direct-acting antiviral therapy and 141 (65.8%) completed therapy, of which 99 (95.2%) achieved a sustained virological response (SVR). PWID were significantly less likely to initiate treatment, while individuals with AUD waited longer before starting treatment. Both people with AUD and PWID were significantly less likely to complete HCV treatment. Conclusions: Overall, SVR was achieved in the majority of the participants treated. However, PWID need better linkage to care and treatment, while PWID and AUD need more support for treatment completion.