Theme: Epidemiology & Public Health Research Year: 2025
| Background: Hepatitis C virus (HCV) disproportionately affects people who use drugs (PWUD), yet treatment uptake remains low due to multilevel barriers. Integrating HCV testing and treatment into opioid treatment programs (OTP) may improve uptake, but predictors of cure among OTP clients remain limited. We identified factors associated with HCV cure among PWUD enrolled in OTPs.
Methods: We analyzed data from OTP clients (aged>18) enrolled in a randomized trial comparing onsite HCV treatment vs. offsite linkage to care at five OTPs in the US and Canada (2021-2023). Baseline questions assessed sociodemographic data, and recent substance use was assessed with urine toxicology. Participant prioritization of HCV was assessed using a five-point Likert-scale response to the statement: “Taking HCV medications is not a priority for me.” Participants rated agreement from 1 (Strongly Agree) to 5 (Strongly Disagree). Logistic regression models identified predictors of HCV cure, defined as undetected HCV RNA ≥10 weeks post-treatment. Results: Among 122 participants, 87 (71%) initiated treatment. Most initiated treatment at OTPs (n=71, 82%) and fewer at offsite specialist centers (n=16, 18%). Of those who initiated treatment, median age was 49.9 years (IQR 38.5-59.1). Most were white (61%), male (62%), and had active substance use (61%) at baseline. Recent homelessness was endorsed by 28.2%. Of those who returned for assessment of cure, n=57/72 (79%) achieved cure. Only prioritization of HCV treatment was significantly associated with HCV cure (aOR=2.83, 95% CI 1.24-6.43) in adjusted models. Substance use (aOR=1.23, 95% CI 0.29-5.23) and homelessness (aOR=0.58, 95% CI 0.11-3.00) were not associated with HCV cure. Conclusion: This study highlights the effectiveness of integrating HCV care into OTPs and underscores that patient-perceived treatment priority is a key determinant of HCV cure, outweighing conventional barriers such as homelessness or substance use. Strategies to enhance HCV treatment prioritization such as education, motivational interviewing or incentives may improve treatment outcomes. |