TY - JOUR
T1 - High HCV cure rates among people who inject drugs and have suboptimal adherence
T2 - A patient-centered approach to HCV models of care
AU - Norton, Brianna L.
AU - Akiyama, Matthew J.
AU - Arnsten, Julia H.
AU - Agyemang, Linda
AU - Heo, Moonseong
AU - Litwin, Alain H.
N1 - Funding Information:
This study received support from Gilead Sciences and NIDA R01 034086.This study was also supported by the Prisma Health and Health Sciences Center Addiction Research Center.
Publisher Copyright:
© 2021
PY - 2021/7
Y1 - 2021/7
N2 - Background: Though people who inject drugs (PWID) make up the majority of the hepatitis C virus (HCV) epidemic, concerns about adherence often exclude PWID from receiving direct-acting antiviral (DAA) medication. The most effective models of HCV care to promote sustained virologic response (SVR) and high adherence need to be evaluated. Methods: We conducted a prospective cohort study in three opioid treatment programs (OTPs) in the Bronx, NY. Participants, in collaboration with providers, chose one of three models of onsite care: directly observed therapy (mDOT), group treatment (GT), or self-administered individual treatment (SIT). SVR12, daily adherence, and participant characteristics were compared between groups. Results: Of 61 participants, the majority were male (62%) and Latino (67%), with a mean age of 53 (SD 9). Participants received DAAs via one of three models of care: mDOT (21%), GT (25%), or SIT (54%). The majority (59%) used illicit drugs during treatment. Overall, SVR12 was 98% with no differences between models of care: mDOT (100%), GT (100%), and SIT (97%) (p = 1.0). Overall, daily adherence was 73% (SD 16); 86% among those who chose mDOT compared to 71% among those who chose GT (p<0.01) and 73% among those who chose SIT (p<0.01). Conclusion: Despite ongoing illicit drug use and suboptimal adherence, SVR12 was high among PWID treated onsite at an OTP using any one of three models of care. Shared decision making in real world settings may be key to choosing the appropriate model of care for PWID.
AB - Background: Though people who inject drugs (PWID) make up the majority of the hepatitis C virus (HCV) epidemic, concerns about adherence often exclude PWID from receiving direct-acting antiviral (DAA) medication. The most effective models of HCV care to promote sustained virologic response (SVR) and high adherence need to be evaluated. Methods: We conducted a prospective cohort study in three opioid treatment programs (OTPs) in the Bronx, NY. Participants, in collaboration with providers, chose one of three models of onsite care: directly observed therapy (mDOT), group treatment (GT), or self-administered individual treatment (SIT). SVR12, daily adherence, and participant characteristics were compared between groups. Results: Of 61 participants, the majority were male (62%) and Latino (67%), with a mean age of 53 (SD 9). Participants received DAAs via one of three models of care: mDOT (21%), GT (25%), or SIT (54%). The majority (59%) used illicit drugs during treatment. Overall, SVR12 was 98% with no differences between models of care: mDOT (100%), GT (100%), and SIT (97%) (p = 1.0). Overall, daily adherence was 73% (SD 16); 86% among those who chose mDOT compared to 71% among those who chose GT (p<0.01) and 73% among those who chose SIT (p<0.01). Conclusion: Despite ongoing illicit drug use and suboptimal adherence, SVR12 was high among PWID treated onsite at an OTP using any one of three models of care. Shared decision making in real world settings may be key to choosing the appropriate model of care for PWID.
KW - HCV
KW - OAT
KW - PWID
KW - Patient centered interventions
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U2 - 10.1016/j.drugpo.2021.103135
DO - 10.1016/j.drugpo.2021.103135
M3 - Article
C2 - 33667826
AN - SCOPUS:85101837347
SN - 0955-3959
VL - 93
JO - International Journal of Drug Policy
JF - International Journal of Drug Policy
M1 - 103135
ER -
