Theme: Epidemiology & Public Health Research Year: 2024
Background: People who use drugs (PWUD) living with hepatitis C virus (HCV) often face barriers accessing treatment due to perceived risks of treatment failure. This study evaluates the efficacy of glecaprevir/pibrentasvir (G/P) in PWUD with active/recent substance use and explores the impact of socioeconomic disparities on treatment outcome.
Methods: A retrospective analysis was conducted with the Kentucky Rural Health Association’s Kentucky Hepatitis Academic Mentorship Program (KHAMP) registry and Central City Concern HCV Elimination Program (CCC-HEP). Objectives: estimate the rate of sustained virologic response (SVR12) for recent/active PWUD treated with 8 weeks of G/P and describe the impact of housing instability and food insecurity on SVR12. Risk for food insecurity was determined by county of residence; housing instability was determined by case report in CCC-HEP and estimated by county of residence in KHAMP. The impact of housing and food insecurity risk were assessed with logistic regression. Cases were included if substance use was reported within 12 months prior to starting treatment with G/P.
Results: 1321 treatment episodes met inclusion criteria, 545 from KHAMP and 776 from CCC-HEP. The observed SVR12 rate was 91.2% (858/941) overall, with 83 RNA positive at SVR12 and 380 missing data or lost-to-follow-up. For PWUD with active/recent use in KHAMP, an estimated 47 cases were at risk for food insecurity and 173 at risk for housing instability, with 97.9% [CI (88.9, 99.6)] and 96% [CI(91.9, 98.0), OR=1.07, CI(0.40,2.89)] achieving SVR12, respectively. For PWUD with active/recent use in CCC, 145 PWUD cases reported housing instability/homelessness and 83.4% [CI (76.6, 88.6)] achieved SVR12 [OR=1.58, CI (0.92,2.73)].
Conclusion: This real-world analysis demonstrated PWUD treated with 8 weeks of G/P achieved high HCV cure rates despite food or housing challenges. Next steps are to enhance provider education and confidence in treating this socioeconomically disadvantaged population to support HCV elimination.
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