High prevalence of willingness to use direct‐acting antiviral‐based regimens for hepatitis C virus (HCV) infection among HIV/HCV coinfected people who use drugs

Abstract

Objectives Despite the high burden of hepatitis C virus (HCV)-related morbidity and mortality among HIV-positive people who use illicit drugs (PWUD), uptake of interferon-based treatments for HCV infection has been negligible among this group. Direct-acting antiviral (DAA) therapies offer an opportunity to expand treatment access among this population. The aim of this study was to explore willingness to use DAA-based regimens among HIV/HCV co-infected PWUD in Vancouver, Canada. Methods Data was drawn from the AIDS Care Cohort to evaluate Exposure to Survival Services (ACCESS), a prospective cohort of HIV-positive PWUD. Using logistic regression analyses we investigated factors associated with willingness to use DAA-based regimens among HIV/HCV co-infected participants. Results Of 418 HIV/HCV co-infected PWUD surveyed between June 2014 and May 2015, 295 (71%) were willing to use DAA-based regimens. In multivariable analysis, participants enrolled in methadone maintenance therapy (Adjusted Odds Ratio [AOR] = 1.61, 95% Confidence Interval [CI]: 1.04–2.51), those with a recent assessment by an HCV specialist (AOR = 2.02, 95% CI: 1.28–3.19), and those who perceived that HCV infection was affecting their health (AOR = 2.49, 95% CI: 1.41–4.37) were more likely to be willing to use DAA-based regimens. Conclusions Overall, this study found high prevalence of willingness to use DAA-based regimens among HIV/HCV co-infected PWUD in Vancouver. Importantly, enrollment in methadone maintenance therapy was positively associated with willingness, suggesting that integrated models of HIV, HCV and addiction care should be explored as a way to address HCV-related morbidity and mortality among HIV/HCV co-infected PWUD.

Barriers to effective management of hepatitis C virus in people who inject drugs: Evidence from outpatient clinics

“…Many practitioners stated that they did not feel that offering it was appropriate in all stages of treatment and that a harm reduction kit was not appropriate for patients receiving DAA. In contrast, studies using a multipronged approach have, in fact, demonstrated successful treatment in PWID . This signals a lack of knowledge among practitioners, which contributes to poorer health outcomes .…”

“I Want to Get Better, But…”: Identifying the Perceptions and Experiences of People Who Inject Drugs With Respect to Evolving Hepatitis C Virus Treatments

“…The scale-up of DAA treatments -with priority to populations who face inequities related to HCV prevalence, incidence, and healthcare access -is To achieve global HCV elimination targets, it has been postulated that a concerted focus on scaling up equitable DAA treatment provision to PWID is required -particularly in countries and regions wherein HCV rates among this population remain high (10)(11)(12)(13). Due, in part, to the sharing of injection drug equipment (e.g., needles, syringes, filters, cookers) and the lack of highquality, effective, and accessible harm reduction services (e.g., supervised consumption sites, needle and syringe distribution programs, opioid agonist therapy [OAT]) in various settings, PWID are inequitably impacted by blood-borne infections, including HCV and human immunodeficiency virus (HIV) (14,15). Indeed, PWID are estimated to comprise 6.1 million (8.5%) of the 71.1 million prevalent chronic HCV cases worldwide, with 25 countries (the majority of which are in North America, Eastern Europe, and East and Southeast Asia) being home to an estimated 82% of the global population of PWID living with HCV (10,16).…”

HIV Serostatus and Having Access to a Physician for Regular Hepatitis C Virus Care Among People Who Inject Drugs

“…11 A growing body of literature indicates a number of barriers, including patient concerns over possible side effects, high cost of DAAs based therapy, fractured social networks, unstable housing, incarceration, and limited engagement in healthcare. 12,13 Furthermore, these factors may be coupled with reluctance on the part of healthcare professionals to initiate DAAs in active PWID due to concerns over HCV reinfection. 14 It is noteworthy that this reluctance may be partially attributed to historical HCV treatment guidelines which have traditionally excluded PWID.…”

“…14 It is noteworthy that this reluctance may be partially attributed to historical HCV treatment guidelines which have traditionally excluded PWID. 12…”