The Role of Adherence Support in Achieving HCV Cure Among People Who Inject Drugs Accessing Harm Reductions Settings in Kenya

Author: Matthew Akiyama Mercy Nyakowa Lindsey Riback Helgar Musyoki John Lizcano Abbe Muller Chenshu Zhang Josephine Walker Jack Stone Peter Vickerman Peter Cherutich Anne Kurth Jack

Theme: Clinical Research Year: 2022


Data are limited on factors associated with sustained virologic response (SVR) among
people who inject drugs (PWID) in lower-middle-income countries (LMICs). The objective of this
study was to evaluate factors associated with SVR in a cohort of PWID treated with direct-acting
antivirals in Kenya.


We recruited PWID accessing medication-assisted treatment (MAT) and needle and
syringe programs (NSP) in Nairobi and Coastal Kenya. All participants were treated with
ledipasvir/sofosbuvir under directly observed therapy (DOT). For those on MAT, DAAs were
dispensed with daily methadone. For those treated in NSPs, peer case mangers (PCMs) supported
onsite DOT and field-based outreach if clients did not attend. We defined treatment completion as
taking all 84 doses regardless of the number of days. We used bivariate and multivariate logistic
regression to examine the impact of sociodemographic, behavioral, and clinical factors on SVR.


Among 95 PWID evaluated for treatment, 87 (91.6%) reported injecting drugs in the last 30
days, 81 (85.3%) were male, 69 (72.6%) were on MAT, 38 (40%) were HIV-positive, 12 (12.6%) were
cirrhotic, and the mean age was 36.5 years (SD=±6.5). Among 92 who initiated treatment. Overall, 85
(92.4%) completed treatment and 79 (85.9%) achieved SVR (intent-to-treat). The average number of
doses taken was 80.0 (SD=±15.3) and maximum days taken for treatment completion was 125. SVR
was associated with neither sociodemographic nor behavioral factors (including recent injection
drug use); however, it was associated with number of doses taken (p=0.01) and treatment
completion (p= 0.001).


Adherence was the most important driver of SVR suggesting DOT in MAT and PCMsupported DOT in NSP settings can overcome other factors that might limit adherence. Further
research is necessary to evaluate other HCV treatment settings and models of HCV treatment given
NSP and MAT access is variable in LMICs, and DOT may not be sustainable with limited resources.

Disclosure of Interest Statement:

See example below:
Funding was provided by Grant Number R01DA032080 from the National Institute on Drug Abuse
(NIDA). MJA is also supported by K99/R00DA043011 and DP2DA053730 from NIDA.

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