Evan B Cunningham1, Behzad Hajarizadeh1, Janaki Amin1,2, Alain H Litwin3,4,5, Edward Gane6, Curtis Cooper7, Karine Lacombe8, Margaret Hellard9,10, Phillip Read1,11, Jeff Powis12, Olav Dalgard13,14, Julie Bruneau15, Gail V Matthews1,16, Jordan J Feld17, John F Dillon18, David Shaw19, Philip Bruggmann20, Brian Conway21, Chris Fraser22, Philippa Marks1, Gregory J Dore1,16, Jason Grebely1. 1. The Kirby Institute, University of New South Wales, Sydney, Australia. 2. Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia. 3. University of South Carolina-Greenville, Greenville, South Carolina, USA. 4. Clemson University, Greenville, South Carolina, USA. 5. Prisma Health, Greenville, South Carolina, USA. 6. Auckland City Hospital, Auckland, New Zealand. 7. Ottawa Hospital Research Institute, Ottawa, Canada. 8. Inserm UMR-S1136, Sorbonne Université, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France. 9. The Burnet Institute, Melbourne, Australia. 10. Department of Infectious Disease, The Alfred Hospital, Melbourne, Australia. 11. Kirketon Road Centre, Sydney, Australia. 12. South Riverdale Community Health Centre, Toronto, Canada. 13. Akershus University Hospital, Oslo, Norway. 14. Institute of Clinical Medicine, University of Oslo, Oslo, Norway. 15. Centre Hospitalier de l'Université de Montréal, Montreal, Canada. 16. St Vincent's Hospital, Sydney, Australia. 17. Toronto General Hospital, Toronto, Canada. 18. Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom. 19. Royal Adelaide Hospital, Adelaide, Australia. 20. Arud Centres for Addiction Medicine, Zurich, Switzerland. 21. Vancouver Infectious Diseases Center, Vancouver, Canada. 22. Coolaid Community Health Centre, Victoria, Canada.
Abstract
BACKGROUND: This study investigated adherence and associated factors among people with recent injection drug use (IDU) or current opioid agonist therapy (OAT) and compared once-daily to twice-daily hepatitis C virus (HCV) direct-acting antiviral (DAA) therapy. METHODS: SIMPLIFY and D3FEAT are international, multicenter studies that recruited participants with recent IDU (previous 6 months; SIMPLIFY, D3FEAT) or current OAT (D3FEAT) between March 2016 and February 2017 in 8 countries. Participants received sofosbuvir/velpatasvir (once daily; SIMPLIFY) or paritaprevir/ritonavir/ombitasvir, dasabuvir (twice daily) ± ribavirin (D3FEAT) for 12 weeks administered in electronic blister packs. We evaluated overall adherence (proportion of prescribed doses taken) and nonadherence (<90% adherent) between dosing patterns. RESULTS: Of 190 participants, 184 (97%) completed treatment. Median adherence was 92%, with higher adherence among those receiving once-daily vs twice-daily therapy (94% vs 87%, P = .005). Overall, 40% of participants (n = 76) were nonadherent (<90% adherent). Recent stimulant injecting (odds ratio [OR], 2.48 [95% confidence interval {CI}, 1.28-4.82]), unstable housing (OR, 2.18 [95% CI, 1.01-4.70]), and twice-daily dosing (OR, 2.81 [95% CI, 1.47-5.36]) were associated with nonadherence. Adherence decreased during therapy. Sustained virologic response was high in nonadherent (89%) and adherent populations (95%, P = .174), with no difference in SVR between those who did and did not miss 7 consecutive doses (92% vs 93%, P = .897). CONCLUSIONS: This study demonstrated high adherence to once- and twice-daily DAA therapy among people with recent IDU or currently receiving OAT. Nonadherence described did not impact treatment outcomes, suggesting forgiveness to nonadherence.
BACKGROUND: This study investigated adherence and associated factors among people with recent injection drug use (IDU) or current opioid agonist therapy (OAT) and compared once-daily to twice-daily hepatitis C virus (HCV) direct-acting antiviral (DAA) therapy. METHODS: SIMPLIFY and D3FEAT are international, multicenter studies that recruited participants with recent IDU (previous 6 months; SIMPLIFY, D3FEAT) or current OAT (D3FEAT) between March 2016 and February 2017 in 8 countries. Participants received sofosbuvir/velpatasvir (once daily; SIMPLIFY) or paritaprevir/ritonavir/ombitasvir, dasabuvir (twice daily) ± ribavirin (D3FEAT) for 12 weeks administered in electronic blister packs. We evaluated overall adherence (proportion of prescribed doses taken) and nonadherence (<90% adherent) between dosing patterns. RESULTS: Of 190 participants, 184 (97%) completed treatment. Median adherence was 92%, with higher adherence among those receiving once-daily vs twice-daily therapy (94% vs 87%, P = .005). Overall, 40% of participants (n = 76) were nonadherent (<90% adherent). Recent stimulant injecting (odds ratio [OR], 2.48 [95% confidence interval {CI}, 1.28-4.82]), unstable housing (OR, 2.18 [95% CI, 1.01-4.70]), and twice-daily dosing (OR, 2.81 [95% CI, 1.47-5.36]) were associated with nonadherence. Adherence decreased during therapy. Sustained virologic response was high in nonadherent (89%) and adherent populations (95%, P = .174), with no difference in SVR between those who did and did not miss 7 consecutive doses (92% vs 93%, P = .897). CONCLUSIONS: This study demonstrated high adherence to once- and twice-daily DAA therapy among people with recent IDU or currently receiving OAT. Nonadherence described did not impact treatment outcomes, suggesting forgiveness to nonadherence.
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