Changes in risk behaviours during and following treatment for hepatitis C virus infection among people who inject drugs: The ACTIVATE study

Midgard, Håvard; Hajarizadeh, Behzad; Cunningham, Evan B; Conway, Brian; Backmund, Markus; Bruggmann, Philip; Bruneau, Julie; Bourgeois, Stefan; Dunlop, Adrian; Foster, Graham R.; Hellard, Margaret; Robaeys, Geert; Thurnheer, Maria Christine; Weltman, Martin; Amin, Janaki; Marks, Philippa; Quiene, Sophie; Dore, Gregory J.; Dalgård, Olav; Grebely, Jason

doi:10.1016/j.drugpo.2017.05.040

Cited by 28 publications

(30 citation statements)

References 52 publications

(43 reference statements)

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“…A study conducted between 2012 and 2014 thus showed, that injection drug use decreased during treatment and follow‐up, and that OST treatment increased among study participants. No significant change in daily injecting habits, use of nonsterile needles or sharing of injecting paraphernalia, was however noted …”

Section: Discussionmentioning

confidence: 88%

Incidence and spontaneous clearance of hepatitis C virus (HCV) in people who inject drugs at the Stockholm Needle Exchange—Importance for HCV elimination

Kåberg

Navér

Hammarberg

et al. 2018

Journal of Viral Hepatitis

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The major transmission route for hepatitis C virus (HCV) is through sharing of unsterile injection equipment among people who inject drugs (PWID). The WHO strategy for HCV elimination by 2030 proposes increased efforts to treat PWID populations that drive the HCV epidemic. Among participants in the Stockholm needle exchange programme (NEP), the HCV prevalence is 60%. We aimed to study HCV incidence, spontaneous HCV clearance rate, and predictors associated with new HCV infections and reinfections in NEP participants. All 2320 patients enrolled in the programme between 8 April 2013 and 23 September 2016 were tested for HCV at baseline, and responded to a questionnaire regarding sociodemographic data and injection risk behaviour. Tests for HCV were repeated at an interval of 3-6 months. The anti-HCV prevalence in the NEP participants at baseline was 77%, and the prevalence of HCV RNA was 57%. 24% of the anti-HCV positive were HCV RNA negative with a spontaneously cleared HCV infection. The overall HCV incidence rate was 22/100 PY. The HCV incidence rate in the HCV naive group was 26/100 PY, and in the spontaneously cleared group 19/100. Although there were no significant differences in becoming HCV infected between the two groups (31% vs 29%), the rate of spontaneous HCV clearance was significantly lower in the HCV naive group, 20% vs 44%, (P < 0.05). A high HCV incidence rate was noted among the PWID indicating that treatment needs to be scaled up in conjunction with harm reduction measures to achieve HCV elimination goals set by WHO. This includes high coverage needle exchange programmes and effective addiction treatment for substance users, including opiate substitution treatment.

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Section: Discussionmentioning

confidence: 88%

Incidence and spontaneous clearance of hepatitis C virus (HCV) in people who inject drugs at the Stockholm Needle Exchange—Importance for HCV elimination

Kåberg

Navér

Hammarberg

et al. 2018

Journal of Viral Hepatitis

View full text Add to dashboard Cite

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“…It has been associated with a decrease in ancillary injecting equipment sharing after treatment completion, suggesting treatment might impact the injecting behaviour as well as HCV. Midgard and colleagues investigated changes in behaviour during and after treatment, and reported a decrease in recent injecting drug use, alcohol use and an increase in opiate substitution therapy (OST) uptake throughout HCV treatment and at follow‐up. However, they found no changes in daily injecting, use of sterile or shared equipment .…”

Section: Introductionmentioning

confidence: 99%

“…Midgard and colleagues investigated changes in behaviour during and after treatment, and reported a decrease in recent injecting drug use, alcohol use and an increase in opiate substitution therapy (OST) uptake throughout HCV treatment and at follow‐up. However, they found no changes in daily injecting, use of sterile or shared equipment . Only a few studies have investigated the effects of HCV treatment on risk behaviour and no literature to date has investigated the role of psychosocial factors such as romantic partnerships and living situation on risk behaviour during and following HCV treatment.…”

Section: Introductionmentioning

confidence: 99%

“…However, they found no changes in daily injecting, use of sterile or shared equipment. 17 Only a few studies have investigated the effects of HCV treatment on risk behaviour 16,17 and no literature to date has investigated the role of psychosocial factors such as romantic partnerships and living situation on risk behaviour during and following HCV treatment.…”

Section: Introductionmentioning

confidence: 99%

“…So it is possible that the patients who were on treatment for HCV and were already enrolled on OST had previously reduced their injecting frequency before starting HCV treatment. Previous studies, however, have attributed decreases in ancillary injecting equipment and decrease in recent injecting drug use to enrolment in HCV treatment 16,17. Enrolment on OST might therefore attenuate the effects of receiving HCV treatment on injecting behaviour.…”

mentioning

confidence: 98%

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

Malaguti

Sani

Stephens

et al. 2018

Journal of Viral Hepatitis

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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.

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Impact and management of patients with multiple hepatitis C virus genotypes

Ferenci

2020

Clinical Dilemmas in Viral Liver Disease

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Changes in risk behaviours during and following treatment for hepatitis C virus infection among people who inject drugs: The ACTIVATE study

Abstract: Recent injecting drug use and hazardous alcohol use decreased, while OST increased during and following HCV treatment among participants with ongoing injecting drug use. These findings support further expansion of HCV care among PWID.

Cited by 28 publications

References 52 publications

Incidence and spontaneous clearance of hepatitis C virus (HCV) in people who inject drugs at the Stockholm Needle Exchange—Importance for HCV elimination

Incidence and spontaneous clearance of hepatitis C virus (HCV) in people who inject drugs at the Stockholm Needle Exchange—Importance for HCV elimination

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

Impact and management of patients with multiple hepatitis C virus genotypes

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