Recruitment and Treatment of Social-Injecting Networks in The Treatment and Prevention Study: A Real-World Social Network Design Community-Based Trial of Direct-Acting Antivirals For Hepatitis C Among People Who Inject Drugs

Author: Rachel Sacks-Davis Tim Spelman Brendan Harney Mellissa Bryant Sally von Bibra Kate Allardice Paul Dietze Mark Stoove Peter Higgs Emma McBryd Heidi Drummer Alexander Thompson Peter Joseph Doyle Margaret Hellard

Theme: Clinical Research Year: 2022

Treating PWID for HCV simultaneously with their peers may reduce HCV incidence through a treatment-asprevention effect. However, little is known about the feasibility of implementing this. The Treatment and Prevention
study was a real-world study of the ‘treat-your-friends’ approach. We aimed to identify individual and network-level
predictors of recruitment of primary participants’ injecting partners and describe their progression through the HCV
care cascade.

At screening, primary participants were asked to nominate people they had recently injected with and refer them for
enrolment as secondary participants. Primary participants also referred additional network members if they injected
with them during the study period (late secondary recruits). Predictors of recruitment into the study were assessed
using multilevel logistic regression, with observations grouped by primary participant.

Overall, 116 primary participants nominated 176 people they had injected with in the six months prior to screening,
and 34% (n=60) were recruited into the study. Relationship closeness and higher frequency of injecting together
were independent predictors of recruitment. Compared to those with a nomination at screening, the late secondary
recruits (n=82) had less relationship closeness with the primary participant. Treatment uptake and sustained
virological response (SVR) testing was higher in HCV RNA positive primary participants (88% and 62%, respectively)
than secondary participants (66% and 43%, respectively). Among those who received an SVR12 test, SVR 12
attainment was similar in primary (87%) and secondary (84%) participants.

Our findings suggest that people may be willing to refer their close contacts early in their treatment journey and to
refer other peers once they have developed a trusting relationship with the treating clinician or service. Lower rates
of treatment uptake and SVR testing among secondary participants suggest that the group recruited through the
treat-your-friends approach may be a harder group to engage in care than the primary participant group.

The Treatment and Prevention Study was supported by an investigator-initiated grant to the Burnet Institute from
Gilead Sciences. JD, MH, and the Burnet Institute receive investigator‐initiated research funding from Gilead
Sciences, Merck, AbbVie, and Bristol‐Myers Squibb. JD is an advisory board member for Gilead Sciences, AbbVie,
Merck. AT is an advisory board member for Gilead Sciences, AbbVie, Bristol‐Myers Squibb, Merck, and Roche
Diagnostics, and a speaker for Gilead, Merck, Bristol‐Myers Squibb, AbbVie, Roche Diagnostics. PH has received
investigator-initiated research funding to his institution from Gilead Sciences and Abbvie. PDietze and MS have
received an investigator‐driven grant from Gilead Sciences. PDietze has received an untied educational grant from
Indivior and has served as an unpaid member of an Advisory Board for Mundipharma. MS has received consultant
fees from Gilead Sciences for activities unrelated to this work. All others have no disclosures to declare.

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