Patterns of drug, alcohol use and injection equipment sharing among people with recent injecting drug use or receiving opioid agonist treatment during and following hepatitis C virus treatment with direct-acting antiviral therapies: An international study.

BACKGROUND: In many settings, recent or prior injection drug use remain barriers to accessing direct-acting antiviral treatment (DAA) for hepatitis C virus (HCV) infection. We examined longitudinal patterns of drug and alcohol use and injection equipment sharing among people with recent injecting drug use or receiving opioid agonist treatment (OAT) during and following DAA-based treatment.

METHODS: SIMPLIFY and D3FEAT are phase IV clinical trials evaluating the efficacy of DAA among people with past six-month injecting drug use or receiving OAT through a network of 25 international sites. Enrolled in 2016-2017, participants received sofosbuvir/velpatasvir (SIMPLIFY) or paritepravir/ritonavir/dasabuvir/ombitasvir±ribavirin (D3FEAT) for 12 weeks. Additionally, they completed a behavioural questionnaire before, during and after treatment, up to two years following treatment initiation. The impact of time in HCV treatment and follow-up on longitudinally measured behavioural outcomes was estimated using generalized estimating equations analyses.

RESULTS: At screening, of 190 participants (mean age: 47; 74% male), 62% reported any past-month injecting (47% opioids, 39% stimulants), 16% past-month injection equipment sharing and 61% current OAT. Median alcohol use was 2 (AUDIT-C test, range 1-12). During follow-up, opioid injecting (OR: 0.95, 95%CI: 0.92-0.99) and sharing (0.87; 95%CI: 0.80-0.94) decreased, whereas no significant changes were observed for stimulant injecting (OR: 0.98, 95%CI: 0.94-1.02) or alcohol use (OR: 0.99; 95%CI: 0.95-1.04). No increasing patterns were noted for any outcome considered.

CONCLUSION: Injecting drug use and risk behaviours remained stable or decreased during and following DAA-based HCV treatment. Findings further support expanding HCV treatment to all, irrespective of injection drug use.