High response and re‐infection rates among people who inject drugs treated for hepatitis C in a community needle and syringe programme

Abstract

Summary To achieve WHO hepatitis C virus (HCV) elimination targets by 2030, mathematical models suggest there needs to be significant scale‐up of treatment among people who inject drugs (PWID). We tested whether people who actively inject drugs can be recruited and treated successfully through a community needle and syringe programme (NSP), and assessed rates of re‐infection. 105 HCV RNA positive participants were enrolled prospectively. Participants were recruited from the largest NSP in Dundee over 42 months. 94/105 individuals commenced treatment. Genotype 1 (G1) individuals (n = 37) were treated with peg‐interferon+ribavirin+Simepravir/Telaprevir. Genotype 2/3 (G2/3) (n = 57) received peg‐interferon+ribavirin. Weekly study visits took place within the NSP. Mean age of participants was 34.0 years (SD 6.9), 71.3% (61/94) were male. One in five (20/94) participants were homeless. 68.1% (64/94) were on OST (opiate substitution therapy) at enrolment; participants injected median 6.5 times/wk. In terms of clinical outcomes, >80% treatment adherence was 71.3% (67/94). There was no difference in SVR‐12 rates by genotype: 81.0% (30/37) for G1 and 82.5% (47/55) for G2/3. At 18 months post‐treatment, 15/77 participants were reinfected, followed up over 69.8 person‐years, yielding a re‐infection rate of 21.5/100 person‐years (95% CI 13.00‐35.65). This trial demonstrates that HCV treatment can be delivered successfully to the target population of treatment as prevention strategies. We report higher rates of re‐infection than existing estimates among PWID. Scale‐up of HCV treatment should be pursued alongside a comprehensive programme of harm reduction interventions to help minimize re‐infection and reduce HCV transmission.

HCV point‐of‐care screening programme and treatment options for people who use drugs in a metropolitan area of Southern Italy

“…Compliance to treatment was excellent and no minor or serious adverse events were reported. Moreover, no re‐infections were recorded at the last visit, unlike previous studies, in which reinfection were reported . This discrepancy might reflect the fact that most of our population was undergoing substitution therapy, whereas the previous studies were conducted in patients enrolled in community and needle syringe programmes in which most subjects are active substance users and are therefore at a higher risk of reinfection than our patients .…”

“…This discrepancy might reflect the fact that most of our population was undergoing substitution therapy, whereas the previous studies were conducted in patients enrolled in community and needle syringe programmes in which most subjects are active substance users and are therefore at a higher risk of reinfection than our patients . Also the shorter follow‐up period (6 months) in our study versus 18 months and beyond in other studies could also explain this discrepancy . However, there is now extensive evidence that PWUD affected by HCV can be successfully targeted and treated …”

How effective and how durable is DAA‐therapy in HCV‐infected drug users?

“…In general, the risk of HCV reinfection should be estimated regarding the specific characteristics of the population studied, but should not withhold treatment providers from treating individuals. In a Scottish NSP with very recent PWID, the HCV reinfection incidence rate was indeed 21.5 per 100 py, and even 34.6 in active PWID below the age of 30 years . Although the incidence rates found by Latham et al are low, it is likely that high reinfection rates will be found, if larger PWID populations are treated.…”

HCV reinfection as a positive indication of high‐risk population treatment access

“…On this background, the Scottish study by Schulkind and colleagues is pivotal public health research. 3 First, it provides HCV treatment outcomes and post-treatment reinfection rates in a truly "current" or "active" PWID population. The enrolment criteria of an episode of injecting drug use within the previous week and the median number of injections within the previous week of 6.5 clearly characterize the study population as high-risk.…”

“…Most studies of current PWID have defined recency of injecting as in the previous six, or even 12 months. 3 Second, the study setting is a needle syringe program (NSP) site, a crucial point of engagement for PWID in relation to HCV prevention, and more recently HCV testing and linkage to care.…”