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Clin Infect Dis. 2019 Jul 11. pii: ciz633. doi: 10.1093/cid/ciz633. [Epub ahead of print]

Patterns of drug, alcohol use and injection equipment sharing among people with recent injecting drug use or receiving opioid agonist treatment during and following hepatitis C virus treatment with direct-acting antiviral therapies: An international study.

Author information

1
Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, Canada.
2
Research Centre, Centre Hospitalier de l'Université de Montréal, Montréal, Canada.
3
The Kirby Institute, UNSW Sydney, Sydney, Australia.
4
Department of Infectious Diseases, St Vincent's Hospital, Sydney Australia.
5
Vancouver Infectious Diseases Centre, Vancouver, Canada.
6
Department of Infectious Disease, Akershus University Hospital, Oslo, Norway.
7
South Riverdale Community Health Centre, Toronto, Canada.
8
Arud Centres for Addiction Medicine, Zurich, Switzerland.
9
Centre for Population Health, The Burnet Institute, Melbourne, VIC, Australia.
10
Department of Infectious Diseases, The Alfred Hospital, Melbourne, VIC, Australia.
11
Ottawa Hospital Research Institute, Ottawa, Canada.
12
Kirketon Road Centre, Sydney, Australia.
13
Toronto General Hospital Research Institute, Toronto, Canada.
14
Department of Health Systems and Populations, Macquarie University, Sydney, Australia.
15
Department of Infectious and Tropical Diseases, Saint-Antoine Hospital, Paris, France.
16
Institut Pierre Louis d'Épidémiologie et de Santé Publique, INSERM, Sorbonne Université, Paris, France.
17
Christchurch Hospital and University of Otago, Christchurch, New Zealand.
18
University of South Carolina School of Medicine, Greenville, South Carolina, United States.
19
Clemson University School of Health Research, Clemson, South Carolina, United States.
20
Prisma Health - Upstate, Greenville, South Carolina, United States.

Abstract

BACKGROUND:

In many settings, recent or prior injection drug use remain barriers to accessing direct-acting antiviral treatment (DAA) for hepatitis C virus (HCV) infection. We examined longitudinal patterns of drug and alcohol use and injection equipment sharing among people with recent injecting drug use or receiving opioid agonist treatment (OAT) during and following DAA-based treatment.

METHODS:

SIMPLIFY and D3FEAT are phase IV clinical trials evaluating the efficacy of DAA among people with past six-month injecting drug use or receiving OAT through a network of 25 international sites. Enrolled in 2016-2017, participants received sofosbuvir/velpatasvir (SIMPLIFY) or paritepravir/ritonavir/dasabuvir/ombitasvir±ribavirin (D3FEAT) for 12 weeks. Additionally, they completed a behavioural questionnaire before, during and after treatment, up to two years following treatment initiation. The impact of time in HCV treatment and follow-up on longitudinally measured behavioural outcomes was estimated using generalized estimating equations analyses.

RESULTS:

At screening, of 190 participants (mean age: 47; 74% male), 62% reported any past-month injecting (47% opioids, 39% stimulants), 16% past-month injection equipment sharing and 61% current OAT. Median alcohol use was 2 (AUDIT-C test, range 1-12). During follow-up, opioid injecting (OR: 0.95, 95%CI: 0.92-0.99) and sharing (0.87; 95%CI: 0.80-0.94) decreased, whereas no significant changes were observed for stimulant injecting (OR: 0.98, 95%CI: 0.94-1.02) or alcohol use (OR: 0.99; 95%CI: 0.95-1.04). No increasing patterns were noted for any outcome considered.

CONCLUSION:

Injecting drug use and risk behaviours remained stable or decreased during and following DAA-based HCV treatment. Findings further support expanding HCV treatment to all, irrespective of injection drug use.

KEYWORDS:

DAA; PWID; drug use; hepatitis C; injecting drug use

PMID:
31300820
DOI:
10.1093/cid/ciz633

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