Psychosocial Factors and the Care Cascade for Hepatitis C Treatment Colocated at a Syringe Service Program

Abstract

Background Direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) is highly effective. However, people who inject drugs face significant barriers to DAA access. Methods We describe a program that colocates HCV management within a syringe service program in New York City. We performed a retrospective chart review of all patients with confirmed HCV viremia. Results From 2015 to 2018, 102 patients with viremia completed intake. Fifty-eight patients started DAAs. Nine patients discontinued treatment or were lost to follow-up before completion; 1 is continuing DAA treatment. Of 48 patients who completed therapy, sustained virologic response (SVR) was achieved in 43 (89.6%). Age and established mental health treatment at intake were associated with SVR. Regular cocaine use was negatively associated with SVR in univariate analysis, but this association was not significant after adjustment for age. Of 30 patients completing DAA therapy with active illicit opioid use at intake, 14 (46.4%) engaged in opioid use disorder (OUD) treatment during therapy, and 9 remained in OUD treatment after completion of DAA treatment. Conclusions Loss to follow-up is a challenge for people who inject drugs, but among those who completed treatment, SVR was achieved at a high rate. Mental health treatment may facilitate HCV cure. Conversely, HCV therapy may facilitate engagement in OUD treatment and other services.

Hepatitis C antibody prevalence, correlates and barriers to care among people who inject drugs in Central California

“…At the time of our study, interferon and DAA medications were both available; however, many states’ Medicaid programs (including CA’s Medi‐Cal) restricted access to DAAs, 64 with prior authorization approvals reserved for patients not engaging in current drug/alcohol use 65 and who had greater disease severity 66 . Although Medicaid has since expanded access to DAAs for the treatment of HCV in many states including CA, 67 recent data show that a significant portion of PWID still do not receive HCV treatment 23,68 . Greater communication between physicians and patients regarding the availability and side effects of DAAs is needed to improve treatment uptake among PWID who have been recommended antivirals.…”

“…66 Although Medicaid has since expanded access to DAAs for the treatment of HCV in many states including CA, 67 recent data show that a significant portion of PWID still do not receive HCV treatment. 23,68 Greater communication between physicians and patients regarding the availability and side effects of DAAs is needed to improve treatment uptake among PWID who have been recommended antivirals.…”

Hepatitis C Testing and Linkage to Care Among Adults on Probation in a Large US City

“…Increased availability of HCV treatment in nonspecialist settings for adults on probation, ideally coupled with patient navigation efforts, could therefore be impactful for this population. Offering on-site HCV treatment at probation departments is also a promising next step and is being explored in other community venues such as syringe services programs [ 26–28 ]. On-site-facilitated telehealth visits is another model that merits further research.…”

Evaluation of cure rate in patients with hepatitis C virus completing shortened courses of treatment

“…This study further supports the need for therapy optimization among patients who use drugs or who are in recovery. 15,16 Read et al 17 evaluated the effectiveness of adherence support in a highly marginalized patient population and found more than 95% cure rates in the enhanced adherence subpopulation. The patient population in this study was similar to that in our case series.…”