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Int J Drug Policy. 2017 Sep;47:187-195. doi: 10.1016/j.drugpo.2017.07.023. Epub 2017 Aug 12.

Implementing and scaling up HCV treatment services for people who inject drugs and other high risk groups in Ukraine: An evaluation of programmatic and treatment outcomes.

Author information

1
ICF Alliance for Public Health in Ukraine, 9th Floor, Building 10A, 5 Dilova (Dymytrova) Str., Kyiv 03150, Ukraine; Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 624 N Broadway, Baltimore, MD 21205, USA. Electronic address: hmazhnaya@gmail.com.
2
ICF Alliance for Public Health in Ukraine, 9th Floor, Building 10A, 5 Dilova (Dymytrova) Str., Kyiv 03150, Ukraine.
3
Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, P.O. Box 208022, New Haven, CT 06520-8022, USA.
4
Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, P.O. Box 208022, New Haven, CT 06520-8022, USA; Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, 60 College Street, P.O. Box 208034, New Haven, CT 06520-8034, USA.

Abstract

BACKGROUND:

HCV prevalence estimates among people who inject drugs (PWID) in Ukraine is high (60-90%), yet barriers to HCV treatment and care remain substantial including limited access to direct acting antiviral (DAA) medications. A feasibility scale-up project implemented HCV treatment in community-based settings to improve access to DAA treatment for key populations in this context.

METHODS:

Using program-level data and verified medical records, we describe the development, implementation processes and outcomes for HCV treatment for PWID and other risks groups. Most participants (76%) received a combination of sofosbuvir, pegylated interferon, and ribavirin for 12 weeks. Treatment enrollment started in June 2015; the first two waves are reported. Data on demographics, HIV characteristics, HCV genotype and RNA levels, including sustained virologic response (SVR) were obtained from verified medical records. We used logistic regression to examine the independent correlates of achieving a SVR.

RESULTS:

The project was implemented in 19 healthcare institutions from 16 regions of Ukraine, mainly within AIDS specialty centers. Our analytical sample included 1126 participants who were mostly men (73%) and the majority were HIV co-infected (79%). Treatment retention was 97.7%; the proportions of participants who achieved SVR for the overall sample and for those with complete data (N=1029) were 86.2% (95% CI 84.08-88.19%) and 94.3% (95% CI 92.8-95.7%) respectively. The analysis of data restricted to only those with SVR data available showed that PWID who were currently injecting had comparable SVR rates (89.2%, 95% CI 81.5-94.5%) to PWID not injecting (94.4%, 95% CI 92.4-96.1), PWID on methadone (94.4%, 95%CI 92.4-96.1), and 'other' risk groups (95.2%, 95% CI 91.3-97.7). Independent factors associated with achieving a SVR were female sex (AOR: 3.44, 95% CI 1.45-8.14), HCV genotype 3 (AOR: 4.57, 95% CI 1.97-10.59) compared to genotype 1. SVR rates in PWID actively injecting did not differ significantly from any other group.

CONCLUSION:

Both patient-level and structural factors influence HCV treatment scale-up in Ukraine, but patient-level outcomes confirm high levels of achieving SVR in PWID, irrespective of injection and treatment status.

KEYWORDS:

DAA; HCV; PWID; Treatment scale-up; Ukraine

PMID:
28811159
PMCID:
PMC5918282
DOI:
10.1016/j.drugpo.2017.07.023
[Indexed for MEDLINE]
Free PMC Article

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