In Iran, HCV testing, linkage to care and treatment is sub-optimal among people who use drugs (PWUD). This study is evaluating the impact of an innovative model of care to enhance HCV testing, linkage to care and treatment among PWUD in Tehran, Iran.

ENHANCE is a non-randomized trial evaluating the effect of on-site HCV rapid antibody testing, venepuncture for HCV RNA testing (HCV antibody positive only), liver fibrosis assessment, and linkage to care to enhance direct-acting antiviral (DAA) therapy (Sovodak®; sofosbuvir/daclatasvir) for HCV among people with a history of drug use. Recruitment is occurring between May-October 2018, through four opioid substitution treatment (OST) clinics and four drop-in centres. Participants initiate DAA therapy at a specialist clinic (OST clinics) or on-site (drop-in centres), with monitoring provided on-site or at the specialist clinic (for those with cirrhosis attending OST clinics).

Among 264 participants (median age, 45 years), 98% were male, and 49% had used drugs in the previous year. Among participants from OST sites (n=186), 42% had used drugs within the previous year, and 26% had a history of HCV testing. HCV prevalence was 18% overall and 53% among those with a history of injecting drug use (IDU). Among drop-in centre participants (n=78), 66% had used drugs within the previous year, and 37% had a history of HCV testing. HCV prevalence was 31% overall and 60% among those with a history of IDU. To date, 100% of participants with HCV infection (n=44) have commenced sofosbuvir/daclatasvir treatment, including 56% who had used drugs within the previous year.

Following on-site HCV testing and linkage to care, HCV treatment uptake was 100% among PWUD in Tehran, Iran. These findings suggest that outreach efforts in OST clinics and non-governmental organisations could be used to enhance diagnosis and treatment uptake among PWUD.