High response and re-infection rates among people who inject drugs treated for hepatitis C in a community needle and syringe programme

Jasmine Schulkind (Lead / Corresponding author), Brian Stephens, Farsana Ahmad, Linda Johnston, Sharon Hutchinson, Donna Thain, Zoe Ward, Peter Vickerman, Matt Hickman, John F. Dillon

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16 Citations (Scopus)
166 Downloads (Pure)

Abstract

To achieve WHO hepatitis C virus (HCV) elimination targets by 2030, mathematical models suggest there needs to be significant scale-up of treatment among people who inject drugs (PWID). We tested whether people who actively inject drugs can be recruited and treated successfully through a community needle and syringe programme (NSP), and assessed rates of re-infection. 105 HCV RNA positive participants were enrolled prospectively. Participants were recruited from the largest NSP in Dundee over 42 months. 94/105 individuals commenced treatment. Genotype 1 (G1) individuals (n = 37) were treated with peg-interferon+ribavirin+Simepravir/Telaprevir. Genotype 2/3 (G2/3) (n = 57) received peg-interferon+ribavirin. Weekly study visits took place within the NSP. Mean age of participants was 34.0 years (SD 6.9), 71.3% (61/94) were male. One in five (20/94) participants were homeless. 68.1% (64/94) were on OST (opiate substitution therapy) at enrolment; participants injected median 6.5 times/wk. In terms of clinical outcomes, >80% treatment adherence was 71.3% (67/94). There was no difference in SVR-12 rates by genotype: 81.0% (30/37) for G1 and 82.5% (47/55) for G2/3. At 18 months post-treatment, 15/77 participants were reinfected, followed up over 69.8 person-years, yielding a re-infection rate of 21.5/100 person-years (95% CI 13.00-35.65). This trial demonstrates that HCV treatment can be delivered successfully to the target population of treatment as prevention strategies. We report higher rates of re-infection than existing estimates among PWID. Scale-up of HCV treatment should be pursued alongside a comprehensive programme of harm reduction interventions to help minimize re-infection and reduce HCV transmission.

Original languageEnglish
Pages (from-to)519-528
Number of pages10
JournalJournal of Viral Hepatitis
Volume26
Issue number5
Early online date13 Nov 2018
DOIs
Publication statusPublished - May 2019

Keywords

  • Hepatitis C virus
  • treatment as prevention
  • people who inject drugs
  • injecting drug use
  • re-infection

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