Mustafizur Rahman1, Naveed Zafar Janjua2, Tanveer Khan Ibne Shafiq3, Ezazul Islam Chowdhury3, Md Safiullah Sarker3, Sharful Islam Khan3, Masud Reza3, Mohammad Omar Faruque4, Ahmedul Kabir5, Aslam H Anis6, Tasnim Azim7. 1. Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh. Electronic address: mustafizur@icddrb.org. 2. British Columbia Centre for Disease Control, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC Canada; CIHR Canadian HIV Trials Network, Vancouver, BC Canada. 3. Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh. 4. Save the Children in Bangladesh, Bangladesh. 5. Dhaka Medical College Hospital, Dhaka, Bangladesh. 6. School of Population and Public Health, University of British Columbia, Vancouver, BC Canada; CIHR Canadian HIV Trials Network, Vancouver, BC Canada. 7. James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh.
Abstract
BACKGROUND: Given the considerable social marginalization experienced by people who inject drugs (PWID), treatment of hepatitis C virus (HCV) in this population presents unique challenges. This study assessed the feasibility of treating HCV infection with direct-acting antiviral (DAA) medications among PWID receiving harm reduction services from a Drop-in-Center in Dhaka, Bangladesh. METHODS: In this prospective study conducted between December 2016 and May 2018, 200 PWID with either recent injecting drug use (i.e., within the previous two months) or a history of injecting drug use and are currently receiving opioid substitution therapy were recruited. Blood was collected to conduct relevant laboratory tests. Eligible PWID who tested positive for HCV RNA (n = 55), were provided daily daclatasvir (60 mg) and sofosbuvir (400 mg) for 12 weeks after which adherence level, sustained virologic response (SVR), and reinfection were assessed. RESULTS: At baseline, 40% (n = 79) of the 200 participants recruited to the study tested positive for antibodies to HCV and 34% (n = 68) had detectable HCV RNA in their blood. Of 55 eligible PWID who initiated treatment, 93% (n = 51) completed treatment while 87% (n = 48) were available for follow-up SVR assessment, all of whom achieved SVR. Thus, intent-to-treat SVR was 87% and the modified intent-to-treat SVR was 100% with one reinfection (4•2 cases per 100 person-years). Further, 75% (i.e., 41 out of the 55 participants) were at least 90% adherent to therapy. CONCLUSION: Our findings strongly suggest that HCV treatment using sofosbuvir+daclatasvir for PWID enrolled in existing harm reduction programs in Bangladesh is feasible but may require additional interventions such as Opioid Substitution Therapy, intense follow up by outreach workers, and services and counselling provided by full time clinicians.
BACKGROUND: Given the considerable social marginalization experienced by people who inject drugs (PWID), treatment of hepatitis C virus (HCV) in this population presents unique challenges. This study assessed the feasibility of treating HCV infection with direct-acting antiviral (DAA) medications among PWID receiving harm reduction services from a Drop-in-Center in Dhaka, Bangladesh. METHODS: In this prospective study conducted between December 2016 and May 2018, 200 PWID with either recent injecting drug use (i.e., within the previous two months) or a history of injecting drug use and are currently receiving opioid substitution therapy were recruited. Blood was collected to conduct relevant laboratory tests. Eligible PWID who tested positive for HCV RNA (n = 55), were provided daily daclatasvir (60 mg) and sofosbuvir (400 mg) for 12 weeks after which adherence level, sustained virologic response (SVR), and reinfection were assessed. RESULTS: At baseline, 40% (n = 79) of the 200 participants recruited to the study tested positive for antibodies to HCV and 34% (n = 68) had detectable HCV RNA in their blood. Of 55 eligible PWID who initiated treatment, 93% (n = 51) completed treatment while 87% (n = 48) were available for follow-up SVR assessment, all of whom achieved SVR. Thus, intent-to-treat SVR was 87% and the modified intent-to-treat SVR was 100% with one reinfection (4•2 cases per 100 person-years). Further, 75% (i.e., 41 out of the 55 participants) were at least 90% adherent to therapy. CONCLUSION: Our findings strongly suggest that HCV treatment using sofosbuvir+daclatasvir for PWID enrolled in existing harm reduction programs in Bangladesh is feasible but may require additional interventions such as Opioid Substitution Therapy, intense follow up by outreach workers, and services and counselling provided by full time clinicians.
Authors: Matthew J Akiyama; Lindsey R Riback; Mercy Nyakowa; Helgar Musyoki; John A Lizcano; Abbe Muller; Chenshu Zhang; Josephine G Walker; Jack Stone; Peter Vickerman; Peter Cherutich; Ann E Kurth Journal: J Viral Hepat Date: 2022-03-15 Impact factor: 3.517
Authors: Nyashadzaishe Mafirakureva; Jack Stone; Hannah Fraser; Yvonne Nzomukunda; Aron Maina; Angela W Thiong'o; Kibango Walter Kizito; Esther W K Mucara; C Inés González Diaz; Helgar Musyoki; Bernard Mundia; Peter Cherutich; Mercy Nyakowa; John Lizcano; Nok Chhun; Ann Kurth; Matthew J Akiyama; Wanjiru Waruiru; Parinita Bhattacharjee; Charles Cleland; Dmytro Donchuk; Niklas Luhmann; Anne Loarec; David Maman; Josephine Walker; Peter Vickerman Journal: Addiction Date: 2021-07-28 Impact factor: 6.526