Theme: Clinical Research Year: 2017
Background: Hepatitis C (HCV) is a significant public health problem that disproportionately afflicts people who inject drugs (PWID). The introduction of direct acting antiviral (DAA) agents for HCV has prompted discussion about potential viral elimination. To maximize the impact of DAAs on the epidemic, more PWIDs need to be treated and cured.
Methods: Data from two prospective pilot programs was used to describe the clinical outcomes of treating HCV in active PWID on-site at a needle syringe program (NSP). Adult participants who injected drugs within the prior 30 days were eligible. Those with decompensated cirrhosis were excluded. Doctors’ visits, blood draws, and medication distribution occurred within the NSP.
Results: 45 participants were enrolled in the HCV treatment program, 34 had prior authorizations submitted, with 26 participants approved, started on therapy, and included in this analysis. Participants had an average age of 45.9 years, 92% men, 46% homeless, and all had active or were eligible for Medicaid. Participants injected a median of 25 times per month, and had been injecting for a average of 19.3 years. 58% were currently receiving opioid substitution therapy. No participants were HIV-infected. 92% of participants were treatment naïve, 58% had genotype 1, and 19% had a fibrosis score ≥F3. Overall, 22/26 (85%) participants achieved a sustained virologic response (SVR12). Three participants discontinued therapy, one due to adverse effects, one due to insurance lapse, and one due to incarceration.
Conclusion: On-site HCV treatment with DAAs of PWID at a needle syringe program is effective, and can achieve high rates of SVR12. NSPs provide a convenient and safe venue to engage HCV infected individuals who are continuing to inject. The rates of re-infection in this population, and the impact of HCV treatment at a NSP on high risk behavior and community wide transmission (cure-as-prevention) need further investigation.