Understanding real-world adherence in the directly acting antiviral era: A prospective evaluation of adherence among people with a history of drug use at a community-based program in Toronto, Canada

Abstract

This study demonstrates that strong adherence and SVR with DAAs is achievable, with appropriate supports, even in the context of substance use, and complex health/social issues.

Implementing and scaling up HCV treatment services for people who inject drugs and other high risk groups in Ukraine: An evaluation of programmatic and treatment outcomes

“…Unlike the HCV elimination project in Georgia where occupationally-exposed persons and those with advanced liver disease were treated first, SVR rates in our sample were 86%, compared to 82% in Georgia. Previous studies of HCV treatment among PWID with DAA have reported that SVR rates exceed 90% (Boglione et al, 2017; Martin et al, 2013; Mason et al, 2017; Read et al, 2017), which is similar to what we found in Ukraine.…”

“…These studies suggest that active drug use during HCV treatment did not impact treatment outcomes (Grebely, Mauss, et al, 2016). Similarly, findings from longitudinal studies in real-world settings confirm these findings with no evidence of association between drug use and treatment non-adherence (Boglione et al, 2017; Mason et al, 2017; Read et al, 2017). …”

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

“…Combined with data presented in a recent publication of this Journal , the evidence base that PWUDs can be treated successfully and achieve SVR in real-world settings is mounting. In all studies, drug use was not related to adherence, attendance for SVR testing, or SVR itself (Mason et al, 2017; Morris et al, 2017; Read et al, 2017). …”

Initiating HCV treatment with direct acting agents in opioid agonist treatment: When to start for people co-infected with HIV?

“…OAT retention is a strong predictor of long-term ART adherence among PWID (Roux et al, 2009), is associated with HCV treatment initiation (Midgard, Bramness, Skurtveit, Haukeland, & Dalgard, 2016), and has been found to improve adherence in studies conducted during the pegylatedinterferon era (Dimova, Zeremski, Jacobson, Hagan, & Des Jarlais, 2013). However, studies of people on OAT and recent injectors have found both populations able to complete a twelve week DAA treatment regimen irrespective of ongoing injecting drug use or OAT (Mason et al, 2017; Morris et al, 2017; Read et al, 2017), and studies which randomized people to immediate or delayed DAA treatment within OAT settings have observed loss to follow-up in the delayed treatment arms (Dore et al, 2016; Hilsden, Macphail, Grebely, Conway, & Lee, 2013). This suggests that ongoing injecting drug use is not associated with reduced response, prolonged delay in DAA initiation within OAT settings should be avoided, and although DAA retention and SVR are achievable outside OAT settings (Mason et al, 2017; Read et al, 2017), OAT remains an important setting for engaging PWID in HCV care and treatment.…”

“…However, studies of people on OAT and recent injectors have found both populations able to complete a twelve week DAA treatment regimen irrespective of ongoing injecting drug use or OAT (Mason et al, 2017; Morris et al, 2017; Read et al, 2017), and studies which randomized people to immediate or delayed DAA treatment within OAT settings have observed loss to follow-up in the delayed treatment arms (Dore et al, 2016; Hilsden, Macphail, Grebely, Conway, & Lee, 2013). This suggests that ongoing injecting drug use is not associated with reduced response, prolonged delay in DAA initiation within OAT settings should be avoided, and although DAA retention and SVR are achievable outside OAT settings (Mason et al, 2017; Read et al, 2017), OAT remains an important setting for engaging PWID in HCV care and treatment. Given the cost of DAA, and concerns regarding treatment adherence and subsequent antiviral resistance, our study provides indirect evidence in support of further implementation science research for DAA treatment initiation time among PWID on OAT without incurring the costs of treatment or drop out.…”