Adherence to once-daily and twice-daily direct acting antiviral therapy for hepatitis C infection among people with recent injection drug use or current opioid agonist therapy

Evan B. Cunningham (Lead / Corresponding author), Behzad Hajarizadeh, Janaki Amin, Alain H. Litwin, Edward Gane, Curtis Cooper, Karine Lacombe, Margaret Hellard, Phillip Read, Jeff Powis, Olav Dalgard, Julie Bruneau, Gail V. Matthews, Jordan J. Feld, John F. Dillon, David Shaw, Philip Bruggmann, Brian Conway, Chris Fraser, Philippa MarksGregory J Dore, Jason Grebely

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3 Citations (Scopus)
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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.

Original languageEnglish
Pages (from-to)e115-e124
Number of pages10
JournalClinical Infectious Diseases
Volume71
Issue number7
Early online date2 Nov 2019
DOIs
Publication statusPublished - 1 Oct 2020

Keywords

  • HCV
  • OAT
  • PWID
  • injection drug users
  • treatment

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