Engaging and Curing Active Drug Users of Hepatitis C


Author: Ahmad F, Johnstone L, Stephens B, Dillon J

Theme: Clinical Research Year: 2015

Introduction:
In Scotland people who inject drugs (PWID) account for over 85% of hepatitis C virus (HCV) diagnosis. Approximately 1% of the Scottish population have been infected with hepatitis C compare to 0.5% in other parts of the UK.

Although people who inject drugs (PWIDS) represent the group most severely affected they are the least likely to receive treatment as they are deemed to be too chaotic and difficult to treat.

The ‘Eradication’ study in Tayside was set up to treat 20 PWID per year in order to reduce the spread of HCV in this population. This step will assess the recruitment process and investigate if it possible to engage, retain and treat these patients for HCV.

Methods:

* Identify HCV positive PWIDS at needle exchange centres in Tayside.

* To assess the suitability for screening and enrol these individuals onto the study.

* Initiate therapy of PEG-Interferon/Ribavirin and a protease inhibitor, if required.

* Offer intensive support on a weekly basis by research nurses and monitor side effects and compliance.

Results:

30 months into a 60 month study, 81 individuals had agreed to participate and were enrolled. 71 have since commenced therapy, 2 await a start date, 3 have stabilised their drug use, with only 3 lost to follow up, 1 spontaneous resolver pre-treatment and 1 had no contraception.

Of those completed treatment 14/16 (87.5%) genotype 1 individuals attained a sustained virological response 12 weeks post-treatment (SVR12). 27 (92.6%) genotype 2 or 3 reached SVR12. Culminating an overall SVR12 rate of 90.5%. 28 are currently on/or await their 3 month post-treatment bloods.

Conclusion:

Engaging and connecting with this chaotic population with the primary outcome of achieving an SVR can be achieved. The overall SVR12 rate was a startling 90.5%, which demonstrates that HCV therapy can be delivered successfully despite ongoing high risk IVDU.

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