Author: Read P, Gilliver R, Kearley J, Lothian R, Cunningham E, Dore GJ

Theme: Clinical Research Year: 2019

Background: A community-based public health facility in Sydney, Australia, the Kirketon Road Centre
(KRC) provides healthcare to people who inject drugs (PWID), homeless and other marginalised
people. Since March 2016, KRC has provided treatment for hepatitis C virus (HCV) with direct acting
antivirals (DAAs). We aimed to evaluate treatment adherence among clients taking DAAs in a highly
marginalised population.
Methods: All clients who commenced DAA therapy prior to March 2018 at KRC were included in this
observational cohort with a subset of clients attending daily or weekly for enhanced adherence
support and dosing. Demographic, behavioural, clinical measures and medication dosing was
recorded and adherence calculated as the proportion of doses taken. Factors associated with
adherence were examined using logistic regression.
Results: 242 individuals commenced DAA therapy, of whom 79 (32%) received enhanced adherence
support. Enhanced support was associated with homelessness, daily injecting, Aboriginality, mental
health co-morbidity and poly-drug use (all p<0.001). Overall adherence was 86%, and 91% of patients missed one or more doses (median 10, IQR 4-24). At least 90% adherence during planned duration was seen in 38%, but increased to 66% by continuing therapy beyond planned duration. General estimating equation demonstrated a trend to adherence reduction over the course of treatment (p=0.071). Late occurrence of first missed dose predicted overall better adherence (aOR=4.59, 95%CI: 1.25-16.93, p=0.022). Overall SVR12 was 68% and 66% in the enhanced adherence support arm, with 29% lost-to-follow up by SVR12 testing. There were only 2 (0.8%) documented virological failures. Conclusion: Adherence support may benefit those with multiple markers of marginalisation, and can optimise treatment outcome. Concerns that poor adherence may compromise virological cure in this population appear unjustified. Extension of therapy beyond planned duration is a pragmatic strategy to enhance completion. Strategies to improve follow-up, particularly post-treatment are required. Disclosure of Interest Statement: The authors have no conflicts of interest to declare.

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