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Abstract Details
Injecting practices during and after hepatitis C treatment and associations with not achieving cure among persons who inject drugs
Drug Alcohol Depend. 2023 Jun 1;247:109878.doi: 10.1016/j.drugalcdep.2023.109878. Epub 2023 Apr 17.
1Division of General Internal Medicine, University of Washington, 325 9th Ave, Seattle, WA98104, USA. Electronic address: tsuij@uw.edu.
2Department of Medicine, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA94110, USA.
3College of Pharmacy, University of Rhode Island, 80 Washington Street, Providence, RI02903, USA; HIV and Viral Hepatitis Services, CODAC Behavioral Health, Providence, RI02909, USA.
4Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615N. Wolfe Street, Room E6546, Baltimore, MD21205, USA.
5Department of Behavioral Medicine & Psychiatry and Department of Medicine, Infectious Diseases, West Virginia University School of Medicine, 930 Chestnut Ridge Road, Morgantown, WV26505, USA.
6Division of Infectious Diseases, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA02114, USA.
7Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 3330 Kossuth Avenue Bronx, NY10467, USA.
8Department of Public Health Sciences, Clemson University, 605 Grove Road, Clemson, SC29605, USA.
9Department of Psychology, Clemson University, 418 Bracket Hall, Clemson, SC29634, USA; Clemson University School of Health Research605 Grove RoadGreenvilleSC29605, USA.
10College of Pharmacy, University of Rhode Island, 80 Washington Street, Providence, RI02903, USA.
11Division of General Internal Medicine, University of Washington, 325 9th Ave, Seattle, WA98104, USA.
12Department of Medicine, University of Pittsburgh, 200 Meyran Ave., Pittsburgh, PA15213, USA.
13Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
14Clemson University School of Health Research605 Grove RoadGreenvilleSC29605, USA; Department of Medicine, University of South Carolina School of Medicine, 876 W Faris Rd, Greenville, SC29605, USA; Department of Medicine, Prisma Health, 876 W Faris Rd, Greenville, SC29605, USA.
Abstract
Background: Persons who inject drugs (PWID) are a key population for hepatitis C virus (HCV) treatment. Study aims were to describe injection practices of PWID during HCV treatment with direct-acting antivirals (DAAs) and assess whether injection practices were associated with not achieving a sustained virologic response (SVR).
Methods: Secondary analysis of the HERO Study (ClinicalTrials.gov, NCT02824640), a pragmatic randomized trial in 8 U.S. states to evaluate the effectiveness of HCV care models among active PWID seen in opioid treatment programs and community clinics. Frequency, sharing and reuse of injecting equipment were assessed at baseline, end-of-treatment (EOT) and quarterly visits up to 60 weeks post-treatment. Generalized Estimating Equations logistic regression models with linear spline were used to compare trends in injecting behaviors during vs. post-treatment. Multivariable logistic regression models explored associations between injecting behaviors during treatment and lack of SVR.
Results: Among 501 participants, 27% were female, 35% were non-white, mean age was 44 (SD 11.5) years and nearly half (49%) were unhoused. At baseline, 41% reported receptive sharing of injecting equipment, declining to 16% at EOT visit. Receptive sharing of cookers, rinses, or needles/syringes during treatment was associated with a nearly 5-fold increase in not achieving SVR (adjusted odds ratio (aOR)=4.83; 95% CI: 2.26, 10.28) as was reuse of one's own needles/syringes (aOR=2.37; 95% CI: 1.11, 4.92).
Conclusions: PWID in the HERO study adopted safer injecting behaviors during DAA treatment; receptive sharing of injecting equipment and reuse of one's own equipment during treatment were associated with not achieving cure.