Hepatitis C Treatment Uptake among Patients Who Have Received Opioid Substitution Treatment: A Population-Based Study

Abstract

Background and AimsThere is limited data on hepatitis C (HCV) treatment uptake among people who inject drugs including individuals receiving opioid substitution treatment (OST). We aimed to calculate cumulative HCV treatment uptake, estimate annual treatment rates, and identify factors associated with HCV treatment among individuals who have received OST in Norway.MethodsThis observational study was based on linked data from The Norwegian Prescription Database and The Norwegian Surveillance System for Communicable Diseases between 2004 and 2013. Both registries have national coverage. From a total of 9919 individuals who had been dispensed OST (methadone, buprenorphine or buprenorphine-naloxone), we included 3755 individuals who had been notified with HCV infection. In this population, dispensions of HCV treatment (pegylated interferon and ribavirin), benzodiazepines, selective serotonin reuptake inhibitors and antipsychotics were studied.ResultsAmong 3755 OST patients notified with HCV infection, 539 (14%) had received HCV treatment during the study period. Annual HCV treatment rates during OST ranged between 1.3% (95% confidence interval [CI] 0.7–2.2) in 2005 and 2.6% (95% CI 1.9–3.5) in 2008 with no significant changes over time. HCV treatment uptake was not associated with age or gender, but associated with duration of active OST (adjusted odds ratio [aOR] 1.11 per year; 95% CI 1.07–1.15), high (> 80%) OST continuity (aOR 1.62; 95% CI 1.17–2.25), and heavy benzodiazepine use (aOR 0.65; 95% CI 0.49–0.87).ConclusionsCumulative HCV treatment uptake among OST patients notified with HCV infection in Norway between 2004 and 2013 was 14%. Annual treatment rates during OST remained unchanged below 3% per year. High continuity of OST over time and absence of heavy benzodiazepine use predicted HCV treatment uptake. Increased awareness for HCV among OST patients is needed as tolerable and efficient directly acting antiviral treatment is being introduced.

Direct‐acting antiviral treatment of chronic HCV‐infected patients on opioid substitution therapy: Still a concern in clinical practice?

“…In most high-income countries, PWID accounted for the majority of people with chronic hepatitis C and new infections [3,4]. As well as the need for an expansion of opioid substitution therapy and accompanying preventive efforts such as education, counselling and needle exchange programmes [27], HCV treatment uptake in this patient group needs to be enhanced [28] to reduce disease burden world-wide. To overcome the reluctance of treating HCV infection in drug users, more data on therapy in this patient group, such as response rates and safety features, might be helpful.…”

Initiating HCV treatment with direct acting agents in opioid agonist treatment: When to start for people co-infected with HIV?

“…dropout from OAT would precipitate dropout from DAA). OAT retention is a strong predictor of long-term ART adherence among PWID (Roux et al, 2009), is associated with HCV treatment initiation (Midgard, Bramness, Skurtveit, Haukeland, & Dalgard, 2016), and has been found to improve adherence in studies conducted during the pegylatedinterferon era (Dimova, Zeremski, Jacobson, Hagan, & Des Jarlais, 2013). However, studies of people on OAT and recent injectors have found both populations able to complete a twelve week DAA treatment regimen irrespective of ongoing injecting drug use or OAT (Mason et al, 2017; Morris et al, 2017; Read et al, 2017), and studies which randomized people to immediate or delayed DAA treatment within OAT settings have observed loss to follow-up in the delayed treatment arms (Dore et al, 2016; Hilsden, Macphail, Grebely, Conway, & Lee, 2013).…”

Feasibility of reaching world health organization targets for hepatitis C and the cost‐effectiveness of alternative strategies

“…Historically, <10% of hepatitis C patients have received treatment in most European countries . In recent years, there has been a slight increase, including Norway, although recent estimates indicate that only about 10% of Norwegian patients with hepatitis C had been cured before the introduction of sofosbuvir in 2014 . The proportion of infected people on treatment stands in sharp contrast to the WHO goals of reducing the incidence of hepatitis C by 90% and mortality by 65% by 2030 (http://apps.who.int/iris/bitstream/10665/246177/1/WHO-HIV-2016.06-eng.pdf?ua=1).…”