C-Free Study: Integrated Model of Care in Curing Hepatitis C in People Who Use Drugs in Thailand
Results from the C-Free study, assessing the impact of an integrated model of care in curing hepatitis C in people who use drugs in Thailand, were published in the Bulletin of the World Health Organization.
The C-Free study enrolled people with current or prior drug use and their partners in a prospective cohort at community drop-in centres providing harm reduction services. Participants were screened for HIV, hepatitis C virus (HCV), hepatitis B virus (HBV) and sexually transmitted infections (STIs). Eligible participants with HCV infection received a 12-week course of sofosbuvir–velpatasvir. The main impact outcome was sustained virological response, measured 12 weeks after treatment completion.
From 2019 to 2023:- 2,871 participants coming from 50 provinces in Thailand were enrolled across 10 study sites in the country, making it one of the largest cohort studies of services for people who use drugs in the world.
- 1,134 participants started treatment for hepatitis C, and 95.1% of those were cured (as per protocol analysis), demonstrating high effectiveness and impact.
- C-Free study results contributed to the removal of drug use as an exclusion criterion for treatment of hepatitis C in the Thai national treatment program in November 2022.
- Reinfection was low, and the cost per HCV cure was estimated at only 28,821 Thai Bahts (or around 907 US$), demonstrating high value for money of these services.
- C-Free partners advocate for government funding support and investment to sustain these community services as part of the national treatment program.
- C-Free documented also antiretroviral treatment for HIV among participants, HBV and STI burden, HBV vaccination uptake, as well as elements of HIV and HCV incidence in the cohort.
The study concluded that community-based HCV treatment of people who use drugs in Thailand, within harm reduction settings, is safe and effective. Integration of this strategy into national programs could enhance HCV elimination in people who use drugs.