Real-world evidence of sofosbuvir/velpatasvir as an effective and simple hepatitis C virus treatment and elimination tool in homeless populations

Lay abstract Reducing the prevalence of HCV in people experiencing homelessness is an important step toward elimination of viral hepatitis as a major public health threat. However, several patient and social factors can complicate treatment. Increasing treatment access and cure rates in this population requires treatment regimens to be simple, effective and well tolerated. In this real-world analysis of data collected from 15 clinical cohorts, a once daily 12-week regimen of sofosbuvir/velpatasvir, requiring minimal monitoring, achieved high cure rates across a broad range of HCV-infected people experiencing homelessness. Background: People experiencing homelessness are disproportionately affected by hepatitis C virus (HCV) and can face specific barriers to care. Simple treatment algorithms could increase linkage to care in this population. Methods: This retrospective real-world analysis pooling data from 15 clinical cohorts evaluated effectiveness of a once-daily sofosbuvir/velpatasvir (SOF/VEL) regimen in HCV-infected people experiencing homelessness. The primary outcome was sustained virological response (SVR) in the effectiveness population (patients with confirmed SVR status). Secondary outcomes included reasons for not achieving SVR, adherence and time between diagnosis and SOF/VEL treatment start. Results: Of 153 patients treated with SOF/VEL for 12 weeks without ribavirin, SVR was 100% in the effectiveness population (n = 122), irrespective of various baseline factors including active injecting drug use and presence of mental health disorders. Conclusion: HCV-infected people experiencing homelessness can successfully be treated with SOF/VEL. SOF/VEL enables implementation of simple treatment algorithms and can support test-and-treat strategies through rapid treatment starts and minimal monitoring.