High HCV cure rates for people who use drugs treated with direct acting antiviral therapy at an urban primary care clinic

Abstract

Background Though direct acting antivirals (DAAs) promise high cure rates, many providers and payers remain concerned about successful treatment for people who use drugs (PWUD), even among those engaged in opioid agonist treatment (OAT). The efficacy of DAAs among PWUD in real-world settings is unclear. Methods We conducted a cohort study of patients initiating HCV treatment between January 2014 and August 2015 (n = 89) at a primary care clinic in the Bronx, NY. Onsite HCV treatment with DAAs was performed by an HCV specialist, with support from a care coordinator funded by the NYC Department of Health. We identified four categories of drug use and drug treatment: (1) no active drug use/not receiving OAT (defined as non-PWUD); (2) no active drug use/receiving OAT; (3) active drug use/not receiving OAT; and (4) active drug use/receiving OAT. The primary outcome was SVR at 12 weeks post-treatment. Results Overall SVR rates were 95% (n = 41/43) for non-PWUD and 96% (n = 44/46) for patients actively using drugs and/or receiving OAT [p = 0.95]. There were no differences in SVR rates by drug use or drug treatment category. Compared to non-PWUD, those with no active drug use/receiving OAT had 100% SVR (n = 15/15; p = 1.0), those actively using drugs/not receiving OAT had 90% SVR (n = 9/10; p = 0.47), and those actively using drugs/receiving OAT had 95% SVR (20/21; p = 1.0). Conclusion Regardless of active drug use or OAT, patients who received DAA therapy at an urban primary care clinic achieved high HCV cure rates. We found no clinical evidence to justify restricting access to HCV treatment for patients actively using drugs and/or receiving OAT.

Elements of community‐based models for treating hepatitis C virus in supporting HCV elimination in Australia: A Delphi study

“…Extensive support for patients including peer support and social and psychological support was particularly important to ensure treatment adherence in interferon‐based treatment because of the long duration and toxicity of the treatment. As the DAA treatment is shorter treatment duration (8‐12 wk) and has fewer side effects, these support arrangements are more applicable for some patients, particularly PWID, patients who are suffering mental health problems, and socially complex and isolated patients …”

“…Linkage with the dispensing pharmacy, having peers as champions of treatment, multidisciplinary teams, and linkage with HCV tertiary services and specialists were also more particularly important in interferon‐based treatments. However, there is still perceived benefits in the era of DAAs …”

“…Thus developing linkage and collaboration with other relevant services can be helpful to ensure the availability of healthcare providers from different disciplines to provide additional services. Although having a linkage with HCV tertiary services and specialists was more important in interferon‐based treatment, nevertheless in the era of DAA, it can be helpful to facilitate referral pathways for cirrhotic and complex patients, ensure post‐treatment follow‐up and facilitate training and support for HCV care providers …”

Clinical effectiveness, cost effectiveness and acceptability of community‐based treatment of hepatitis C virus infection: A mixed method systematic review

“…One study failed to describe the study participants and setting in detail, one study did not clearly mention how the exposure (receiving care at the community settings) was measured . The majority of studies failed to address confounders such as patients’ socioeconomic characteristics, HIV or HBV co‐infections, history of HCV treatment and types of healthcare providers . The other criteria (standard criteria for measuring the condition, valid and reliable way for measuring the outcomes and appropriate statistical analysis) were met by all studies.…”

Improving hepatitis C direct‐acting antiviral access and uptake: A role for patient‐reported outcomes and lived experience

“…Whilst adherence to DAA treatment in clinical trials has been extremely high, there are existing concerns that adherence rates will drop in real‐world settings, particularly among those with indicators of social marginalization, including PWID . However, thus far real‐world studies have demonstrated relatively high DAA treatment adherence among PWID, those with mental health comorbidities and those experiencing homelessness, particularly when treatment is administered through integrated care, community‐based or nurse led programs or in conjunction with adherence support . Sensitive patient‐reported outcome measures, which capture mental health, relationships with healthcare and social isolation may be used to link individuals with appropriate care in order to maximise adherence.…”