Association Between Opioid Agonist Therapy and Testing, Treatment Uptake, and Treatment Outcomes for Hepatitis C Infection Among People Who Inject Drugs: A Systematic Review and Meta-analysis

Abstract

Background People who inject drugs (PWID) experience barriers to accessing testing and treatment for hepatitis C virus (HCV) infection. Opioid agonist therapy (OAT) may provide an opportunity to improve access to HCV care. This systematic review assessed the association of OAT and HCV testing, treatment, and treatment outcomes among PWID. Methods Bibliographic databases and conference presentations were searched for studies assessing the association between OAT and HCV testing, treatment, and treatment outcomes [direct-acting antiviral (DAA) therapy only] among people who inject drugs (in the past year). Meta-analysis was used to pool estimates. Results Among 9,877 articles identified, 22 studies conducted in Australia, Europe, North America, and Thailand were eligible and included. Risk of bias was serious in 21 studies and moderate in one study. Current/recent OAT was associated with an increased odds of recent HCV antibody testing [4 studies; odds ratio (OR), 1.80; 95% CI:1.36, 2.39), HCV RNA testing among those who were HCV antibody positive (2 studies; OR, 1.83; 95% CI:1.27, 2.62), and DAA treatment uptake among those who were HCV RNA positive (7 studies; OR 1.53; 95% CI: 1.07, 2.20). There was insufficient evidence of an association between OAT and treatment completion (9 studies) or sustained virologic response following DAA therapy (9 studies). Conclusions Opioid agonist therapy can increase linkage to HCV care, including uptake of HCV testing and treatment among PWID. This supports the scale-up of OAT as part of strategies to enhance HCV treatment to further HCV elimination efforts.

Association between opioid agonist therapy use and HIV testing uptake among people who have recently injected drugs: a systematic review and meta‐analysis

“…Our results are consistent with findings of other studies demonstrating the benefits of OAT use in reducing harms across multiple health outcomes for people who are opioid-dependent [36]. OAT use has been shown to improve engagement in HIV treatment uptake, adherence and viral suppression, as well as engagement in hepatitis C testing and treatment [12,37,38]. OAT use is also associated with a reduced risk of HIVand HCV infections [14,15].…”

“…This may be due to the different risk factors associated with stimulant, rather than heroin injection, including the sexual transmission of HIV within the men who have sex with men (MSM) community [47]. However, although some PWID in the studies included in our review may be injecting stimulants rather than opioids, a recent systematic review on OAT use and hepatitis C testing and treatment noted that the proportion of PWID who reported ever using opioids was 95-100%, indicating that this issue is unlikely to have substantially biased our findings [38].…”

Hepatitis C treatment in a co‐located mental health and alcohol and drug service using a nurse‐led model of care

“…OAT is potentially a proxy for healthcare engagement and health seeking behaviour among people who inject drugs with a body of literature providing evidence that OAT prescription improves engagement in clinical care, 29 and reduces risk of HCV infection, 30 including reinfection 31 . Furthermore, evidence indicates that OAT is associated with HCV DAA treatment 32 including in Australia 33 . In our integrated service providing services for psychiatric, addiction and physical health such as HCV, OAT also offers additional supports with medication dispensing and might be accompanied by ad hoc reminders about HCV treatment adherence.…”

Modelling the Impact of Prevention and Treatment Interventions on HIV and Hepatitis C Virus Transmission Among People Who Inject Drugs in Kenya

“…[17] This testing could occur through existing harm reduction interventions or OST clinics as demonstrated by two recent pilot HCV screening and treatment interventions in Kenya, which both achieved a high proportion (82-95%) of diagnosed PWID completing treatment[6]. Expanding OST would also have other benefits through reducing drug-related mortality as well as improving HIV and HCV testing and treatment outcomes among PWID[14, 34, 35]. This could also improve the effectiveness of HIV and HCV treatment for reducing HIV and HCV transmission[36].…”