Injection drug users have long comprised the largest and, in many ways, most challenging population in the field of hepatitis C. They have historically been difficult to bring into care and prone to high-risk behaviors that lead to reinfection.
Competing physical and mental health care priorities are increased in people who inject drugs (PWID), which has makes it necessary to be careful about the tenor and nature of talking points throughout the continuum of care. For understandable reasons, adherence in the interferon era was inconsistent, and data are still emerging as to whether PWID are more adherent to direct-acting antiviral therapies. But now that those therapies are becoming more accessible, HCV Next tackled these issues head-on in a question-and-answer format with a host of experts in the clinical and research fields.
The experts include Erik Sorem Anderson, MD, clinical instructor in the department of emergency medicine at Stanford University in Palo Alto, and attending physician in the department of emergency medicine at Highland Hospital in Oakland Calif.; Kirk Dombrowski, PhD, John G. Bruhn Professor of Sociology and director of the University of Nebraska at Lincoln Minority Health Disparities Initiative; Camila Gelpi-Acosta, PhD, an assistant professor of criminal justice at the City University of New York and supporter of El Punto en la Montaña, a grassroots syringe exchange program in Puerto Rico; Mark Hull, MD, a clinical associate professor at University of British Columbia, and research scientist at the BC Centre for Excellence in HIV/AIDS; and Julio Montaner, MD, DSc, Director of the BC Centre for Excellence in HIV/AIDS.
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Q: How can we best ensure adherence to therapy in this population?
Hull: Adherence is an important component of providing HCV care in any setting. A number of strategies have been used successfully in PWID, including linking HCV medications to other medication programs such as methadone/opiate substitution therapies (OST) or antiretrovirals (both of which are often delivered in a daily fashion, and can be witnessed), dispensing medications in blister packs and involving adherence supports, such as HCV treatment groups or peer support programs.
Montaner: Over the next few years, the BC Centre for Excellence in HIV/AIDS will be actively investigating how to improve engagement and adherence in treatment for hepatitis C. In this context, we have received a grant from our provincial government to monitor and evaluate the overall impact of the ongoing roll-out of HCV therapy in British Columbia, and to establish a prospective research cohort of individuals successfully treated for HCV, to characterize HCV reinfection rates among populations at increased risk for reinfection (eg, PWID, people living with HIV, men who have sex with men, etc.). We will also aim to determine the threshold of risk reduction engagement that minimizes the likelihood of HCV reinfection.