TOPLINE:

On-site hepatitis C virus (HCV) testing and treatment with peer support at opioid treatment programs resulted in more than fourfold higher treatment initiation, as well as higher cure rates than referral to off-site specialists.

METHODOLOGY:

• Researchers conducted a randomized trial across five opioid treatment programs in the US and Canada between August 2021 and November 2023 to evaluate the clinical effectiveness of an integrated, peer-supported HCV test-and-treat strategy vs referral to off-site specialty HCV care.
• A total of 122 participants (mean age, 48 years; 60% men) with reactive HCV antibody tests received either on-site opioid treatment program-delivered HCV test and treat with peer support (n = 66) or referral to off-site specialist care (n = 56) and were included in the modified intention-to-treat analysis.
• Participants in both groups had access to fixed-dose combination 100 mg glecaprevir with 40 mg pibrentasvir, taken as three tablets daily for 8 weeks, while those in the referral group were given contact information to schedule appointments at local off-site specialist HCV treatment centers.
• The primary outcome was HCV treatment initiation within 12 weeks of randomization, while secondary outcomes included time to treatment initiation up to 24 weeks; treatment completion, defined as taking ≥ 90% of the prescribed course; and sustained virologic response, defined as HCV RNA < 15 IU/mL measured 10-36 weeks after the completion of treatment.

TAKEAWAY:

• Overall, 89% of participants in the on-site care group compared with 21% in the referral group-initiated HCV treatment within 12 weeks (risk difference, 67%; P < .001).
• The median time to treatment initiation was 20 days for participants in the on-site care group compared with 168 days for those in the referral group (P < .001).
• Overall, 64% of participants in the on-site care group compared with 17% in the referral group completed the treatment (risk difference, 46%; P < .001).
• Sustained virologic response was achieved by 61% of participants in the on-site care group compared with 14% in the referral group (risk difference, 46%; P < .001).

IN PRACTICE:

“[Our] findings support policy reform and expanded resources to support HCV treatment integration into OTPs [opioid treatment programs] to advance progress towards HCV elimination,” the authors of the study wrote.

SOURCE:

This study was led by Oluwaseun Falade-Nwulia, MBBS, MPH, Johns Hopkins University School of Medicine, Baltimore. It was published online on March 24, 2026, in The Lancet Regional Health - Americas.

LIMITATIONS:

The study was limited by incomplete outcome ascertainment because of challenges with blood draws and loss to follow‑up. Commercial laboratory testing prevented viral sequencing to distinguish reinfection from treatment failure. Also, providing glecaprevir/pibrentasvir at no cost meant that real‑world access barriers, such as prior‑authorization requirements, were not assessed. The predominantly male and White study sample may have limited generalizability.

DISCLOSURES:

This study was funded by AbbVie. Five authors reported receiving grant support from the funders for this research. Several authors also reported receiving grant support, personal payment as consulting fees and honoraria, as well as meeting attendance/travel support from various pharmaceutical companies and institutions. One author reported serving as chair of the Data Safety Monitoring Board for two trials, and another reported serving as editor-in-chief of the Journal of Viral Hepatitis.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.