The Impact of Current Opioid Agonist Therapy on Hepatitis C Virus Treatment Initiation Among People Who Use Drugs From the Direct-acting Antiviral (DAA) Era: A Population-Based Study

Abstract

Background Evidence that opioid agonist therapy (OAT) is associated with increased odds of hepatitis C virus (HCV) treatment initiation among people who use drugs (PWUD) is emerging. The objective of this study was to determine the association between current OAT and HCV treatment initiation among PWUD in a population-level linked administrative dataset. Methods The British Columbia (BC) Hepatitis Testers Cohort was used for this study, which includes all people tested for or diagnosed with HCV in BC, linked to medical visits, hospitalizations, laboratory, prescription drug, and mortality data from 1992 until 2019. PWUD with injecting drug use or opioid use disorder and chronic HCV infection were identified for inclusion in this study. HCV treatment initiation was the main outcome, and subdistribution proportional hazards modeling was used to assess the relationship with current OAT. Results 13,803 PWUD with chronic HCV were included in this study. Among those currently on OAT at the end of the study period, 47% (2,704/5,770) had started HCV treatment, whereas 22% (1778/8033) of those not currently on OAT has started HCV treatment .. Among PWUD with chronic HCV infection, current OAT was associated with higher likelihood of HCV treatment initiation in time to event analysis (adjusted hazard ratio 1.84 [95%CI, 1.50, 2.26]). Conclusions Current OAT was associated with a higher likelihood of HCV treatment initiation. However, many PWUD with HCV currently receiving OAT have yet to receive HCV treatment. Enhanced integration between substance use care and HCV treatment is needed to improve the overall health of PWUD.

Integrated Hepatitis C–Opioid Use Disorder Care Through Facilitated Telemedicine

“…Our qualitative data suggest that an HCV cure fosters self-confidence, promoting overall well-being . Our observation of significant decreases in illicit drug use among HCV-cured participants is consistent with prior studies that showed improved HCV and opioid use disorder treatment outcomes with simultaneous treatment of both entities . Although desired, physical integration of medical and behavioral therapy has been difficult to achieve; OTP-integrated facilitated telemedicine appears to integrate HCV and opioid use disorder care with improved convenience, accessibility, and flexibility.…”

Adherence to opioid agonist therapy predicts uptake of direct-acting antivirals in people who use drugs: results from the French national healthcare database (the ANRS FANTASIO study)

“…As OAT prescription is monthly in France, 20% of the time corresponds to two or more OAT prescriptions in the previous six The second important result is that only 15% of PWUD with chronic HCV infection in our study received DAA treatment between 2014 and 2016, suggesting that treating strategies were suboptimal in this population. Our results are consistent with previous studies conducted in other countries which have already highlighted that OAT access is a major predictor of DAA uptake [11,20,21]. Interestingly, women, as demonstrated elsewhere [15], had fewer opportunities to initiate DAA despite tending to be more adherent to OAT.…”

Canadian Addiction Treatment Centre (CATC) opioid agonist treatment cohort in Ontario, Canada

“…OAT effectively reduces cravings and withdrawal symptoms enabling patients to achieve physical, mental and emotional stability 9. Prolonged and sustained engagement with OAT is associated with a reduced likelihood of overdoses, mortality and infections such as hepatitis C virus (HCV) and HIV 12–14. Consequently, OAT is associated with lowered healthcare costs and improved overall quality of life 9 15 16.…”