Change in injecting behaviour among people treated for hepatitis C virus: The role of intimate partnerships

Abstract

Summary Injecting behaviour in people who inject drugs is the main risk factor for hepatitis C virus (HCV) infection. Psychosocial factors such as having a partner who injects drugs and living with other drug users have been associated with increases in injecting risk behaviour. This study aimed to investigate changes in injecting behaviour during treatment for HCV infection whilst exploring the role of psychosocial factors on patients’ injecting behaviour. Eradicate‐C was a single‐centred clinical trial (ISRCTN27564683) investigating the effectiveness of HCV treatment within the injecting drug‐using population between 2012 and 2017. A total of 94 participants completed up to 24 weeks of treatment, with social and behavioural measures taken at different intervals throughout treatment. Data for 84 participants were analysed retrospectively to explore mechanisms of potential behavioural changes which had occurred during treatment. Injecting frequency reduced significantly between baseline (week 1) and every 4‐weekly interval until week 26. Not being on opiate substitution therapy (OST) was associated with a statistically significant decrease in injecting frequency, χ2 (1) = 10.412, P = 0.001, as was having a partner who also used drugs, in particular when that partner was also on treatment for HCV infection, Z = −2.312, P = 0.021. Treating a hard‐to‐reach population for HCV infection is not only possible, but also bears health benefits beyond treatment of HCV alone. Enrolling couples on HCV treatment when partners are sero‐concordant has shown enhanced benefits for reduction in injecting behaviour. Implications for practice are discussed.

Impact of Hepatitis C treatment on behavioural change in relation to drug use in people who inject drugs: A systematic review

“…The following variables were collected: first author, title, publication year, full paper or abstract, primary aim, study design, location, setting, total study duration, follow up period, sample characteristics, sample size, intervention, outcome/ measure of behaviour change, main results, conclusions. The authors of Malaguti et al (2019) were contacted for clarification regarding follow up period in their study. The authors of Artenie et al (2019) were contacted to obtain updated data, and they kindly provided an unpublished manuscript relating to their INHSU conference abstract.…”

“…Moreover, the authors mention a lack of statistical power due to the relatively small sample size, providing a second explanation of lack of significant findings. A second study by Malaguti et al (2019) investigated changes in weekly injecting frequency between enrolment, during treatment and at 6 months follow up. Results showed a significant decrease in injecting frequency between enrolment and future time points (χ 2 (7) = 36.44, p< .001, n= 32), with the largest reduction in injecting reported between enrolment and week 8 of treatment, maintained through to 6 months follow up.…”

“…In regards to impact of treatment on other behavioural changes related to drug use, findings are more inconsistent. For instance, of the two studies which investigated the impact of treatment on injecting frequency, only one study observed a significant decline in injecting frequency between enrolment, treatment, and follow up (Malaguti et al, 2019). Nonetheless, comparing the findings of these studies is not suitable due to the contrasting measurements of injecting frequency; namely weekly injecting, measured as a continuous variable (Malaguti et al, 2019), and ≥ daily injecting, measured as a binary variable (Midgard et al, 2017).…”