Optimal Adherence during HCV Treatment amongst Active Drug Users at a Community Based Program in Toronto, Canada

Author: Powis Ja, Mason Kb, Dodd Zb, Sockalingam Sc, Altenberg Jb

Theme: Clinical Research Year: 2016

Powis Ja
, Mason Kb
, Dodd Zb
, Sockalingam Sc
, Altenberg Jb
a. Department of Medicine, University of Toronto; Toronto East General Hospital, Toronto,
b. South Riverdale Community Health Centre, Toronto, Canada
c. Department of Psychiatry, University of Toronto; Medical Psychiatry Program, University
Health Network, Toronto, Canada
Background: Direct acting antiviral (DAA) treatment regimens for Hepatitis C (HCV) are now
widely available. Adherence to DAAs is a major predictor of sustained virologic response
(SVR), yet few real world trials exist evaluating adherence among people who use drugs. We
evaluated adherence among clients receiving DAA treatment from a multidisciplinary,
community-based program
Methods: This study included chronic HCV patients initiating treatment with DAAs without
interferon. A self-report medication adherence questionnaire was completed weekly. Pre/post
treatment questionnaires examined socio-demographics, co-morbid conditions and substance
use. Optimal adherence was defined has having no days when medication was missed for the
intended duration of treatment. Weekly optimal adherence rates were evaluated.
Results: 59 participants were enrolled. 73% were male with average age of 53 years. 86%
had a history of injection drug use (IDU) with 10% reporting IDU in the past 30 days. 29%
reported non-injection illicit drug use (not including marijuana) in the past 30 days and 17%
heavy alcohol use in the same period. Treatment regimes included: 22% SOF/LED for 8
weeks, 49% SOF/LED for 12 weeks, 2% SOF/LED for 24 weeks; 8% SOF/RBV for 12 weeks
and 19% SOF/RBV for 24 weeks. Of the 59 who initiated treatment, 46 completed, 2
discontinued and 11 remain on therapy. Based on intention to treat (ITT), optimal adherence at
week 4 & 8 was 50/59 (85%) and 45/59(76%). EOT was 82%(9/11), 76%(22/29), 50%(4/8)%
for 8, 12 & 24 treatment durations respectively. EOT responses were available for 39 with an
ITT of 95%. SVR rates were available in 17 with an ITT rate of 82%.
Conclusion: This study provides insight into the adherence patterns of marginalized people
living with HCV and demonstrates that despite high rates of substance use, a communitybased model of HCV treatment can support positive HCV treatment outcomes.
Disclosure: Nothing to disclose

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