Theme: Epidemiology & Public Health Research Year: 2024
Background: Disparities persist in accessing and benefiting from direct-acting antiviral (DAA) hepatitis C (HCV) medications among people who are unsheltered or unstably housed. Understanding these patient experiences is critical to supporting optimal adherence and cure.
Methods: We conducted a secondary analysis of a US clinical trial (NCT03987503; NOW Trial) offering initiation of SOF/VEL at point-of-diagnosis, with the goal of capturing patient experiences with medication adherence. Self-report questionnaires, with repeated open- and close-ended questions, were administered biweekly for 12 weeks. Patterns were analyzed using summary statistics and trend tests.
Results: Eighty-seven (N=87) participants initiated treatment, of which 97% had an income below the national poverty line, 80% had recently injected drugs, and 62% were taking additional prescription medication. Sixty-one percent were unsheltered and 65% moved their sleeping location at least once of the course of treatment (range: 0, 14). Of those who started treatment, all took at least one tablet. Sixty-nine completed treatment, 58 attained SVR12, and 2 stopped treatment due to low adherence. Among those who completed treatment, adherence was 77% (95% CI: 73%, 81%) and among those who did not, adherence was 32% (95% CI: 18%, 46%). Both groups’ adherence rates declined over the course of treatment, however their adherence trends significantly diverged starting at week four of treatment (p-value: <0.001). Common challenges to adherence were housing instability and insecurity of belongings. Participants reported storing medication in their backpack or pocket 45%, near their sleeping place 27%, and in a locked location 27%. The need to conceal medication ran counter to facilitators reported by participants which included visual cues, secure storage, and a consistent dosing routine.
Conclusion: Our results highlight nuances in HCV medication adherence experiences among a group on treatment for HCV and underline the importance of housing first policies and the provision of adherence support throughout treatment.
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