Theme: Epidemiology & Public Health Research Year: 2017
Background: Direct-acting antiviral (DAA) HCV therapy has been shown to be effective
among people who inject drugs (PWID), but there is limited research on HCV treatment
among PWID in the real-world, particularly primary care settings. The aim of this
analysis was to assess the efficacy of DAA therapy for chronic HCV among people with
a history of substance use attending a community health centre.
Methods: This is a retrospective study of participants attending an inner-city community
health centre in Victoria, Canada. Participants with a history of substance use (noninjecting or injecting drug use, or alcohol use determined by chart review) were included
if they initiated treatment between November 2014 through October 2016 and were due
for sustained virological response (SVR) by April 1, 2017. The primary endpoint was
SVR12.
Results: Of 166 participants who initiated treatment, 19% had HIV/HCV coinfection,
32% were receiving OST, and 65% had ongoing substance use (54% injecting drug
use). Overall, 97.5% (n=162) completed treatment, including two lost-to-follow-up (LTF)
during treatment (1.2%) and two deaths (1.2%). Overall, 87% (144/166) achieved
SVR12 in intent-to-treat analyses. Among those without SVR, 15 were lost to follow-up
and four died. No reinfection has been documented to date. There was no difference in
SVR12 by HIV status (HIV, 90% vs. no HIV, 86%, P=0.77), OST (OST, 87% vs. no
OST, 87%, P=1.00), ongoing substance use (yes, 88% vs. no, 84%, P=0.63), and
injecting drug use (yes, 90% vs. no, 84%, P=0.26).
Conclusion: This retrospective study demonstrates that DAA treatment is effective,
with no observed reinfections in a highly complex inner city cohort of people with
ongoing substance use within a primary care setting. Our findings further demonstrate
the efficacy of treating vulnerable populations within the context of primary care and
provide a rationale for expanded primary care services of HCV.
Disclosure of Interest Statement: CACHC is part of the Victoria Cool Aid Society, a
non-profit organization. We receive support for our health programming from AbbVie
Corporation, Gilead Sciences, Merck Canada.