Andreea A Artenie1,2, Evan B Cunningham3, Gregory J Dore3,4, Brian Conway5, Olav Dalgard6, Jeff Powis7, Philip Bruggmann8, Margaret Hellard9,10, Curtis Cooper11, Philip Read3,12, Jordan J Feld13, Behzad Hajarizadeh3, Janaki Amin3,14, Karine Lacombe15,16, Catherine Stedman17, Alain H Litwin18,19,20, Pip Marks3, Gail V Matthews3,4, Sophie Quiene3, Amanda Erratt3, Julie Bruneau1,2, Jason Grebely3. 1. Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Canada. 2. Research Centre, Centre Hospitalier de l'Université de Montréal, Canada. 3. Kirby Institute, University of New South Wales, Australia. 4. Department of Infectious Diseases, St Vincent's Hospital, Sydney, Australia. 5. Vancouver Infectious Diseases Centre, Canada. 6. Department of Infectious Disease, Akershus University Hospital, Oslo, Norway. 7. South Riverdale Community Health Centre, Toronto, Canada. 8. Arud Centres for Addiction Medicine, Zurich, Switzerland. 9. Centre for Population Health, Burnet Institute, Australia. 10. Department of Infectious Diseases, Alfred Hospital, Melbourne, Victoria, Australia. 11. Ottawa Hospital Research Institute, Canada. 12. Kirketon Road Centre, Sydney, Australia. 13. Toronto General Hospital Research Institute, Canada. 14. Department of Health Systems and Populations, Macquarie University, Sydney, Australia. 15. Department of Infectious and Tropical Diseases, Saint-Antoine Hospital, Paris, France. 16. Institut Pierre Louis d'Épidémiologie et de Santé Publique, INSERM, Sorbonne Université, Paris, France. 17. Department of Medicine, University of Otago, New Zealand. 18. Department of Medicine, School of Medicine Greenville, University of South Carolina. 19. Department of Medicine, School of Health Research, Clemson University, Greenville, South Carolina. 20. Prisma Health-Upstate, Greenville, South Carolina.
Abstract
BACKGROUND: In many settings, recent or prior injection drug use remains a barrier to accessing direct-acting antiviral treatment (DAA) for hepatitis C virus (HCV) infection. We examined patterns of drug and alcohol use and injection equipment sharing among people with recent injecting drug use or receiving opioid agonist treatment (OAT) during and following DAA-based treatment. METHODS: SIMPLIFY and D3FEAT are phase 4 trials evaluating the efficacy of DAA among people with past 6-month injecting drug use or receiving OAT through a network of 25 international sites. Enrolled in 2016-2017, participants received sofosbuvir/velpatasvir (SIMPLIFY) or paritaprevir/ritonavir/dasabuvir/ombitasvir ± ribavirin (D3FEAT) for 12 weeks and completed behavioral questionnaires before, during, and up to 2 years posttreatment. The impact of time in HCV treatment and follow-up on longitudinally measured longitudinally measured behaviors was estimated using generalized estimating equations. RESULTS: At screening, of 190 participants (mean age, 47 years; 74% male), 62% reported any past-month injecting 16% past-month injection equipment sharing, and 61% current OAT. Median alcohol use was 2 (Alcohol Use Disorders Identification Test-Consumption; range, 1-12). During follow-up, opioid injecting (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.92-0.99) and sharing (OR, 0.87; 95% CI, 0.80-0.94) decreased, whereas no significant changes were observed for stimulant injecting (OR, 0.98; 95% CI, 0.94-1.02) or alcohol use (OR, 0.99; 95% CI, 0.95-1.04). CONCLUSIONS: Injecting drug use and risk behaviors remained stable or decreased following DAA-based HCV treatment. Findings further support expanding HCV treatment to all, irrespective of injection drug use. CLINICAL TRIALS REGISTRATION: SIMPLIFY, NCT02336139; D3FEAT, NCT02498015.
BACKGROUND: In many settings, recent or prior injection drug use remains a barrier to accessing direct-acting antiviral treatment (DAA) for hepatitis C virus (HCV) infection. We examined patterns of drug and alcohol use and injection equipment sharing among people with recent injecting drug use or receiving opioid agonist treatment (OAT) during and following DAA-based treatment. METHODS:SIMPLIFY and D3FEAT are phase 4 trials evaluating the efficacy of DAA among people with past 6-month injecting drug use or receiving OAT through a network of 25 international sites. Enrolled in 2016-2017, participants received sofosbuvir/velpatasvir (SIMPLIFY) or paritaprevir/ritonavir/dasabuvir/ombitasvir ± ribavirin (D3FEAT) for 12 weeks and completed behavioral questionnaires before, during, and up to 2 years posttreatment. The impact of time in HCV treatment and follow-up on longitudinally measured longitudinally measured behaviors was estimated using generalized estimating equations. RESULTS: At screening, of 190 participants (mean age, 47 years; 74% male), 62% reported any past-month injecting 16% past-month injection equipment sharing, and 61% current OAT. Median alcohol use was 2 (Alcohol Use Disorders Identification Test-Consumption; range, 1-12). During follow-up, opioid injecting (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.92-0.99) and sharing (OR, 0.87; 95% CI, 0.80-0.94) decreased, whereas no significant changes were observed for stimulant injecting (OR, 0.98; 95% CI, 0.94-1.02) or alcohol use (OR, 0.99; 95% CI, 0.95-1.04). CONCLUSIONS: Injecting drug use and risk behaviors remained stable or decreased following DAA-based HCV treatment. Findings further support expanding HCV treatment to all, irrespective of injection drug use. CLINICAL TRIALS REGISTRATION: SIMPLIFY, NCT02336139; D3FEAT, NCT02498015.
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