Predictors of hepatitis C cure among people who inject drugs treated with directly observed therapy supported by peer case managers in Kenya

Matthew J. Akiyama; Lindsey R. Riback; Mercy Nyakowa; Helgar Musyoki; John A. Lizcano; Abbe Muller; Chenshu Zhang; Josephine G. Walker; Jack Stone; Peter Vickerman; Peter Cherutich; Ann E. Kurth

doi:10.1016/j.drugpo.2023.103959

Predictors of hepatitis C cure among people who inject drugs treated with directly observed therapy supported by peer case managers in Kenya

Matthew J. Akiyama, Lindsey R. Riback, Mercy Nyakowa, Helgar Musyoki, John A. Lizcano, Abbe Muller, Chenshu Zhang, Josephine G. Walker, Jack Stone, Peter Vickerman, Peter Cherutich, Ann E. Kurth

Medicine

Research output: Contribution to journal › Article › peer-review

Abstract

Background & Aims: Directly observed therapy (DOT) maximizes adherence and minimizes treatment gaps. Peer case managers (PCM) have also shown promise as a component of integrated HCV treatment strategies. DOT and PCM-support have been underexplored, particularly in low- and middle-income countries (LMICs). The objective of this study was to evaluate predictors of sustained virologic response (SVR) among people who inject drugs (PWID) attending medication-assisted treatment (MAT) and needle and syringe programs (NSP) sites in Kenya. Methods: We recruited PWID accessing MAT and NSP in Nairobi and Coastal Kenya. PWID were treated with ledipasvir/sofosbuvir using DOT supported by PCMs. We used bivariate and multivariate logistic regression to examine the impact of sociodemographic, behavioral, and clinical factors on SVR. Results: Among 92 PWID who initiated HCV treatment, 79 (86%) were male with mean age of 36.3 years (SD=±6.5); 38 (41%) were HIV-positive, and 87 (95%) reported injecting drugs in the last 30 days. Just over half of participants were genotype 1a (55%), followed by genotype 4a (41%) and mixed 1a/4a (3%). Most participants, 85 (92%) completed treatment and 79 (86%) achieved SVR. While sociodemographic and behavioral factors including recent injection drug use were not significantly associated with achieving SVR, being fully adherent (p=0.042), number of doses taken (p=0.008) and treatment completion (p= 0.001) were associated with higher odds of achieving SVR. Conclusions: DOT with PCM-support was an effective model for HCV treatment among PWID in this LMIC setting. Adherence was the most important driver of SVR suggesting DOT and PCM support can overcome other factors that might limit adherence. Further research is necessary to ascertain the effectiveness of other models of HCV care for PWID in LMICs given NSP and MAT access is variable, and DOT may not be sustainable with limited resources.

Original language	English (US)
Article number	103959
Journal	International Journal of Drug Policy
Volume	113
DOIs	https://doi.org/10.1016/j.drugpo.2023.103959
State	Published - Mar 2023

Keywords

Africa
DAA
HCV
LMIC
PWID
Peer

ASJC Scopus subject areas

Medicine (miscellaneous)
Health Policy

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.drugpo.2023.103959

Cite this

Akiyama, M. J., Riback, L. R., Nyakowa, M., Musyoki, H., Lizcano, J. A., Muller, A., Zhang, C., Walker, J. G., Stone, J., Vickerman, P., Cherutich, P., & Kurth, A. E. (2023). Predictors of hepatitis C cure among people who inject drugs treated with directly observed therapy supported by peer case managers in Kenya. International Journal of Drug Policy, 113, Article 103959. https://doi.org/10.1016/j.drugpo.2023.103959

Akiyama, MJ, Riback, LR, Nyakowa, M, Musyoki, H, Lizcano, JA, Muller, A, Zhang, C, Walker, JG, Stone, J, Vickerman, P, Cherutich, P & Kurth, AE 2023, 'Predictors of hepatitis C cure among people who inject drugs treated with directly observed therapy supported by peer case managers in Kenya', International Journal of Drug Policy, vol. 113, 103959. https://doi.org/10.1016/j.drugpo.2023.103959

@article{6a9fb9f4f87341888b438cd89acf9013,

title = "Predictors of hepatitis C cure among people who inject drugs treated with directly observed therapy supported by peer case managers in Kenya",

abstract = "Background & Aims: Directly observed therapy (DOT) maximizes adherence and minimizes treatment gaps. Peer case managers (PCM) have also shown promise as a component of integrated HCV treatment strategies. DOT and PCM-support have been underexplored, particularly in low- and middle-income countries (LMICs). The objective of this study was to evaluate predictors of sustained virologic response (SVR) among people who inject drugs (PWID) attending medication-assisted treatment (MAT) and needle and syringe programs (NSP) sites in Kenya. Methods: We recruited PWID accessing MAT and NSP in Nairobi and Coastal Kenya. PWID were treated with ledipasvir/sofosbuvir using DOT supported by PCMs. We used bivariate and multivariate logistic regression to examine the impact of sociodemographic, behavioral, and clinical factors on SVR. Results: Among 92 PWID who initiated HCV treatment, 79 (86%) were male with mean age of 36.3 years (SD=±6.5); 38 (41%) were HIV-positive, and 87 (95%) reported injecting drugs in the last 30 days. Just over half of participants were genotype 1a (55%), followed by genotype 4a (41%) and mixed 1a/4a (3%). Most participants, 85 (92%) completed treatment and 79 (86%) achieved SVR. While sociodemographic and behavioral factors including recent injection drug use were not significantly associated with achieving SVR, being fully adherent (p=0.042), number of doses taken (p=0.008) and treatment completion (p= 0.001) were associated with higher odds of achieving SVR. Conclusions: DOT with PCM-support was an effective model for HCV treatment among PWID in this LMIC setting. Adherence was the most important driver of SVR suggesting DOT and PCM support can overcome other factors that might limit adherence. Further research is necessary to ascertain the effectiveness of other models of HCV care for PWID in LMICs given NSP and MAT access is variable, and DOT may not be sustainable with limited resources.",

keywords = "Africa, DAA, HCV, LMIC, PWID, Peer",

author = "Akiyama, {Matthew J.} and Riback, {Lindsey R.} and Mercy Nyakowa and Helgar Musyoki and Lizcano, {John A.} and Abbe Muller and Chenshu Zhang and Walker, {Josephine G.} and Jack Stone and Peter Vickerman and Peter Cherutich and Kurth, {Ann E.}",

note = "Publisher Copyright: {\textcopyright} 2023 Elsevier B.V.",

year = "2023",

month = mar,

doi = "10.1016/j.drugpo.2023.103959",

language = "English (US)",

volume = "113",

journal = "International Journal of Drug Policy",

issn = "0955-3959",

publisher = "Elsevier",

}

TY - JOUR

T1 - Predictors of hepatitis C cure among people who inject drugs treated with directly observed therapy supported by peer case managers in Kenya

AU - Akiyama, Matthew J.

AU - Riback, Lindsey R.

AU - Nyakowa, Mercy

AU - Musyoki, Helgar

AU - Lizcano, John A.

AU - Muller, Abbe

AU - Zhang, Chenshu

AU - Walker, Josephine G.

AU - Stone, Jack

AU - Vickerman, Peter

AU - Cherutich, Peter

AU - Kurth, Ann E.

PY - 2023/3

Y1 - 2023/3

N2 - Background & Aims: Directly observed therapy (DOT) maximizes adherence and minimizes treatment gaps. Peer case managers (PCM) have also shown promise as a component of integrated HCV treatment strategies. DOT and PCM-support have been underexplored, particularly in low- and middle-income countries (LMICs). The objective of this study was to evaluate predictors of sustained virologic response (SVR) among people who inject drugs (PWID) attending medication-assisted treatment (MAT) and needle and syringe programs (NSP) sites in Kenya. Methods: We recruited PWID accessing MAT and NSP in Nairobi and Coastal Kenya. PWID were treated with ledipasvir/sofosbuvir using DOT supported by PCMs. We used bivariate and multivariate logistic regression to examine the impact of sociodemographic, behavioral, and clinical factors on SVR. Results: Among 92 PWID who initiated HCV treatment, 79 (86%) were male with mean age of 36.3 years (SD=±6.5); 38 (41%) were HIV-positive, and 87 (95%) reported injecting drugs in the last 30 days. Just over half of participants were genotype 1a (55%), followed by genotype 4a (41%) and mixed 1a/4a (3%). Most participants, 85 (92%) completed treatment and 79 (86%) achieved SVR. While sociodemographic and behavioral factors including recent injection drug use were not significantly associated with achieving SVR, being fully adherent (p=0.042), number of doses taken (p=0.008) and treatment completion (p= 0.001) were associated with higher odds of achieving SVR. Conclusions: DOT with PCM-support was an effective model for HCV treatment among PWID in this LMIC setting. Adherence was the most important driver of SVR suggesting DOT and PCM support can overcome other factors that might limit adherence. Further research is necessary to ascertain the effectiveness of other models of HCV care for PWID in LMICs given NSP and MAT access is variable, and DOT may not be sustainable with limited resources.

AB - Background & Aims: Directly observed therapy (DOT) maximizes adherence and minimizes treatment gaps. Peer case managers (PCM) have also shown promise as a component of integrated HCV treatment strategies. DOT and PCM-support have been underexplored, particularly in low- and middle-income countries (LMICs). The objective of this study was to evaluate predictors of sustained virologic response (SVR) among people who inject drugs (PWID) attending medication-assisted treatment (MAT) and needle and syringe programs (NSP) sites in Kenya. Methods: We recruited PWID accessing MAT and NSP in Nairobi and Coastal Kenya. PWID were treated with ledipasvir/sofosbuvir using DOT supported by PCMs. We used bivariate and multivariate logistic regression to examine the impact of sociodemographic, behavioral, and clinical factors on SVR. Results: Among 92 PWID who initiated HCV treatment, 79 (86%) were male with mean age of 36.3 years (SD=±6.5); 38 (41%) were HIV-positive, and 87 (95%) reported injecting drugs in the last 30 days. Just over half of participants were genotype 1a (55%), followed by genotype 4a (41%) and mixed 1a/4a (3%). Most participants, 85 (92%) completed treatment and 79 (86%) achieved SVR. While sociodemographic and behavioral factors including recent injection drug use were not significantly associated with achieving SVR, being fully adherent (p=0.042), number of doses taken (p=0.008) and treatment completion (p= 0.001) were associated with higher odds of achieving SVR. Conclusions: DOT with PCM-support was an effective model for HCV treatment among PWID in this LMIC setting. Adherence was the most important driver of SVR suggesting DOT and PCM support can overcome other factors that might limit adherence. Further research is necessary to ascertain the effectiveness of other models of HCV care for PWID in LMICs given NSP and MAT access is variable, and DOT may not be sustainable with limited resources.

KW - Africa

KW - DAA

KW - HCV

KW - LMIC

KW - PWID

KW - Peer

UR - http://www.scopus.com/inward/record.url?scp=85147804489&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85147804489&partnerID=8YFLogxK

U2 - 10.1016/j.drugpo.2023.103959

DO - 10.1016/j.drugpo.2023.103959

M3 - Article

C2 - 36758335

AN - SCOPUS:85147804489

SN - 0955-3959

VL - 113

JO - International Journal of Drug Policy

JF - International Journal of Drug Policy

M1 - 103959

ER -

Predictors of hepatitis C cure among people who inject drugs treated with directly observed therapy supported by peer case managers in Kenya

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this