Randomized clinical trial: Direct-acting antivirals as treatment for hepatitis C in people who inject drugs: delivered in needle and syringe programs via directly observed therapy versus fortnightly collection

Lewis Beer (Lead / Corresponding author), Sarah Inglis, Amy Malaguti, Christopher Byrne, Christian Sharkey, Emma Robinson, Kirsty Gillings, Andrew Radley, Adrian Hapca, Brian Stephens, John Dillon

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Abstract

Hepatitis C virus (HCV) treatment in people who inject drugs (PWID) is delivered within settings frequented by PWID, such as needle and syringe programs (NSP). The optimal direct-acting antiviral (DAA) dispensing regimen among NSP clients is unknown. This study compared cures (Sustained virologic response 12 weeks post-treatment, [SVR 12]) across three dispensing schedules to establish non-inferiority of fortnightly dispensing versus directly observed therapy. The ADVANCE HCV study was a randomized, unblinded trial, recruiting PWID attending NSP in Tayside, Scotland, between January 2018 and November 2019. HCV-positive participants were randomized to receive DAAs via directly observed therapy, fortnightly provision or fortnightly provision with psychological intervention. A modified intention to treat analysis was used to identify differences in cures between the three treatment regimes. The study was registered with clinicaltrials.gov; NCT03236506. A total of 110 participants completed the study. 33 participants received directly observed therapy, with 90.91% SVR 12; 37 received fortnightly provision, with 86.49% SVR 12 and 40 received fortnightly provision and psychological intervention at treatment initiation, with 92.50% SVR 12. Analysis showed no significant difference in SVR 12 (p = 0.67). This study did not demonstrate a statistically significant difference in cure rate between groups. This provides evidence of the non-inferiority of fortnightly dispensing of direct-acting antivirals (DAAs) compared to directly observed therapy among PWID. It suggests that tight control of adherence through directly observed therapy dispensing of DAAs among this population offers no therapeutic advantage. Therefore, less restrictive dispensing patterns can be used, tailored to patient convenience.

Original languageEnglish
Pages (from-to)646-653
Number of pages8
JournalJournal of Viral Hepatitis
Volume29
Issue number8
Early online date18 May 2022
DOIs
Publication statusPublished - Aug 2022

Keywords

  • direct-acting antivirals
  • hepatitis c
  • needle and syringe programs
  • randomized controlled trial

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