Knowledge of hepatitis C and treatment willingness amongst people who inject drugs in an era of direct acting antivirals

Abstract

Background Knowledge of hepatitis C virus (HCV) is believed to be important in altering risk behaviour, improving engagement in care, and promoting willingness to initiate HCV treatment. We assessed factors associated with HCV knowledge and treatment willingness amongst people who inject drugs (PWID) in an era of direct acting antivirals. Methods Data were derived from three prospective cohort studies of PWID in Vancouver, Canada, between June 2014 and May 2015. HCV knowledge and treatment willingness were assessed using a Likert scale. Multivariable linear regression identified factors associated with higher HCV knowledge and treatment willingness. Results Amongst 630 participants, mean scores for HCV knowledge and treatment willingness were 25.41 (standard deviation [SD]: 2.52) out of 30, and 6.83 (SD: 1.83) out of 10, respectively. In multivariable analyses, Caucasian ancestry (adjusted linear regression model estimate [β] 0.50; 95% confidence interval [CI] 0.17, 0.82), employment (β 0.76; 95% CI: 0.38, 1.13), diagnosed mental health disorder (β 0.44; 95% CI: 0.11, 0.78) and previous HCV treatment (β 0.94; 95% CI: 0.46, 1.43) were independently associated with higher knowledge. Downtown Eastside (DTES) residence (i.e., epicenter of Vancouver’s drug scene) was independently associated with lower knowledge (β −0.48; 95% CI: −0.81, −0.15). Greater HCV knowledge (β 0.12; 95% CI: 0.07, 0.17) was independently associated with higher HCV treatment willingness. DTES residence (β −0.31; 95% CI: −0.56, −0.06) and daily crack cocaine smoking (β −0.52; 95% CI: −0.92, −0.13) were independently associated with lower treatment willingness. Conclusion Socioeconomic factors, such as neighborhood residence and employment, were associated with HCV knowledge. Higher HCV knowledge was associated with more HCV treatment willingness. Our findings suggest that increasing HCV knowledge amongst PWID may be an integral component of the HCV cascade of care and that efforts might be best targeted to individuals with greater socioeconomic disadvantage.

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 [35][36][37][38][39][40]. This signals a lack of knowledge among practitioners, which contributes to poorer health outcomes [27].…”

Non-invasive liver fibrosis assessment and HCV treatment initiation within a systematic screening program in HIV/HCV coinfected patients

“…Particularly people who inject drugs [ 2 ] need to be addressed by customized concepts. A higher knowledge of HCV is associated with increased willingness for HCV treatment [ 37 ] and thus a general lack of awareness of HCV is still a major concern [ 38 ]. Moser et al [ 39 ] recently described a promising approach to address patients who are on opioid substitution therapy.…”

We know DAAs work, so now what? Simplifying models of care to enhance the hepatitis C cascade

“…Amongst PWID and other vulnerable populations, rapid testing has been shown to substantially increase coverage and referral rates . To date, many services have not been developed for vulnerable populations such as the homeless, PWID and prisoners, which must both contend with numerous social determinants that contribute to poor quality of life and poor social functioning as well as health inequalities . It should be emphasized that HCV treatment should be offered based on clinical rather than social factors or injecting‐related behaviours , underlining the necessity of overcoming obstacles to HCV treatment delivery to PWID.…”