Changes in Injection Drug Use among Recently Hepatitis C Virus-Infected Persons who Inject Drugs Offered Treatment in Montreal, Canada

Author: Artenie A, Zang G, Jutras-Aswad D, Turcotte M, Bouchard R, Puzhko S, Deschenes É, Bruneau J

Theme: Epidemiology & Public Health Research Year: 2015

It is unclear whether offering hepatitis C virus (HCV) treatment to people who inject drugs (PWID) can positively impact injection drug use behaviours. This study examined changes in injection drug use among recently HCV-infected PWID systematically referred for HCV Clinical Research assessment and treatment and offered targeted health care services, over the course of one year.

The study sample included PWID with documented HCV seroconversion recruited and followed-up semi-annually at least twice in IMPACT (2007- 2014), a longitudinal prospective study in Montreal, Canada. Participants with contra-indications to treatment due to severe physical or psychiatric co-morbidity were offered targeted health care services. Pegylated interferon-alpha (12–24weeks) was offered to all other participants who did not spontaneously resolve their infection. At each study visit, data were collected on socio-demographic factors, drug use patterns and health care services use. Logistic regression was used to assess changes in injection drug use at one-year follow-up.

Of the 68 eligible participants (mean age: 35.6; 75.0% male), 26.5% received treatment [(RT), Sustained virologic response: 61.1%], 25% spontaneously resolved their infection (SR), 13.2% had a contra-indication (CI) and 35.3% refused (R). The R group was less likely to report regular medical care during follow-up relative to the other three groups (p<0.001). In multivariate analyses adjusting for age, gender and injection drug use at baseline, the RT [Adjusted odds ratio (AOR): 0.21; 95%Confidence interval (CI): 0.04, 1.05)], SR (AOR: 0.21; 95%CI: 0.04, 1.07), and CI (AOR: 0.14; 95%CI: 0.02, 0.95) groups were less likely to report injection drug use compared to the R group at follow-up. Conclusion: PWID who received treatment, spontaneously resolved their infection or presented with a treatment contra-indication reported reduced injection drug use at follow-up relative to those who refused therapy. Greater exposure to regular medical care during follow-up could partially explain these changes.

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