Daily Dosing Of Direct Acting Antivirals (DAA) From A Public Opioid Substitution Treatment (OST) Program For Marginalised Clients In Kings Cross, Sydney

Author: Gilliver R, Chronister KJ, Lothian R, Kearley J, Machin W, Read P

Theme: Models of Care Year: 2018

The Kirketon Road Centre (KRC) is a publicly funded primary health care service in Kings
Cross, Sydney. KRC provides prevention, treatment and care of viral hepatitis with a focus
on people who inject drugs and operates a targeted OST program.
Description of model of care:
With the introduction of DAAs in Australia, KRC sought to support treatment and provide
additional flexibility for clients. Clients commencing treatment were offered an option to
receive daily or weekly medication through our OST program. Such individualised
adherence support options are now part of KRC’s model of care.
A total of 122 clients participated in KRC’s OST program for at least 4 weeks from March
2016 to February 2018. The mean age was 36 years, 53% were female and 48% Aboriginal.
The median duration in OST during the time period was 44 weeks. Hepatitis C status was
able to confirmed in 102 clients, of whom 67 (66%) were RNA positive. Of these, 52 (78%)
commenced DAAs, 42 dosing daily or weekly and 10 self-managing. Among these clients,
48 (92%) completed treatment with 29 tested at SVR12 thus far, all of whom were cured.
Reasons for not initiating treatment included: incarceration, relocation, and loss to follow-up.
Of the clients treated, 30 (58%) were also receiving psychiatric medication through KRC’s
OST, 24 (46%) were homeless, 50 (96%) reported current drug use, 25 (48%) sex workers,
7 (13%) were co-infected with HIV.
Conclusion and next steps:
This study demonstrates that a flexible model of care, including daily or weekly dosing of
DAAs through an OST program, can achieve high treatment completion and cure rates for
marginalised clients. Reasons for not commencing DAAs or confirming SVR12, were often
due to the transient nature of this population.
Disclosure of Interest Statement:
The authors have no conflicts of interest to declare

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