Having More HIV Infected Network Members In Care Is Associated With Increased HCV Treatment Uptake Among People Who Inject Drugs

Author: Falade-Nwulia O, Sacamano P, Yang C, Thomas D, Sulkowski M, Latkin C, Mehta S

Theme: Epidemiology & Public Health Research Year: 2017

People who inject drugs (PWID) have high rates of hepatitis C virus (HCV) and HIV infection. Oral direct acting agents (DAA) of short duration with minimal side effects lead to HCV cure in over 95% of people. However, HCV treatment uptake among PWID remains low; social network members (NMs) have the potential to increase uptake.

The AIDS linked to the IntraVenous Experience (ALIVE) cohort follows PWID in Baltimore. Egocentric network data assessing characteristics of PWID networks was collected using a network inventory. HCV/HIV status were determined from antibody results. HCV treatment uptake was defined as self-report of treatment initiation. Logistic regression was used to assess the association between individual/network factors and HCV treatment uptake.

Among 265 HCV-infected PWID, the median age was 59 (IQR 51-60) years, 68% were male, majority were Black (86%), 36% were HIV co-infected, and 26% reported injection drug use in the past 30 days. Only 42 (16%) reported a history of HCV treatment. Treated participants were likely to be older (mean age 58 vs 55 years, p=0.01) and be HIV/HCV co-infected PWID (versus HCV mono-infected PWID) (OR 3.1, 95% CI 1.6-6.2). PWID reported a median of four NMs (IQR 2-5) most of whom were kin (median 2, IQR 1-3). Having more HIV-infected NMs and discussing HIV care with the index PWID was associated with HCV treatment initiation by the index PWID (OR 3.0, 95% CI 1.5-5.9). After adjusting for age and HIV status, having more NMs who discussed their HIV care remained significantly associated with HCV treatment uptake (OR 2.6, 95% CI 1.1-6.0).

HCV treatment uptake appeared to be influenced by positive interactions with HIV-infected NMs in care. Interventions to improve HIV engagement and support sharing of HIV-related health information with HIV-infected and uninfected peers may improve HCV treatment uptake among peers.

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