Adherence to Once-daily and Twice-daily Direct-acting Antiviral Therapy for Hepatitis C Infection Among People With Recent Injection Drug Use or Current Opioid Agonist Therapy

Evan B Cunningham; Behzad Hajarizadeh; Janaki Amin; Alain H Litwin; Edward Gane; Curtis Cooper; Karine Lacombe; Margaret Hellard; Phillip Read; Jeff Powis; Olav Dalgard; Julie Bruneau; Gail V Matthews; Jordan J Feld; John F Dillon; David Shaw; Philip Bruggmann; Brian Conway; Chris Fraser; Philippa Marks; Gregory J Dore; Jason Grebely; SIMPLIFY and D3FEAT study groups

doi:10.1093/cid/ciz1089

Adherence to Once-daily and Twice-daily Direct-acting Antiviral Therapy for Hepatitis C Infection Among People With Recent Injection Drug Use or Current Opioid Agonist Therapy

Clin Infect Dis. 2020 Oct 23;71(7):e115-e124. doi: 10.1093/cid/ciz1089.

Authors

Evan B Cunningham¹, Behzad Hajarizadeh¹, Janaki Amin^{1

2}, Alain H Litwin^{3

4

5}, Edward Gane⁶, Curtis Cooper⁷, Karine Lacombe⁸, Margaret Hellard^{9

10}, Phillip Read^{1

11}, Jeff Powis¹², Olav Dalgard^{13

14}, Julie Bruneau¹⁵, Gail V Matthews^{1

16}, Jordan J Feld¹⁷, John F Dillon¹⁸, David Shaw¹⁹, Philip Bruggmann²⁰, Brian Conway²¹, Chris Fraser²², Philippa Marks¹, Gregory J Dore^{1

16}, Jason Grebely¹; SIMPLIFY and D3FEAT study groups

Collaborators

SIMPLIFY and D3FEAT study groups:
Jason Grebely, Gregory Dore, Olav Dalgard, Philip Bruggmann, Catherine Stedman, Karine Lacombe, Jeff Powis, Margaret Hellard, Sione Crawford, Tracy Swan, Jude Byrne, Melanie Lacalamita, Evan Cunningham, Behzad Hajarizadeh, Jason Grebely, Gregory Dore, Pip Marks, Ineke Shaw, Sharmila Siriragavan, Janaki Amin, Sophie Quiene, Kathy Petoumenos, Patrick Schmid, Erika Castro, Alberto Moriggia, Karine Lacombe, Jean-Pierre Daulouede, Olav Dalgard, Brian Conway, Christopher Fraser, Jeff Powis, Jordan Feld, Julie Bruneau, Curtis Cooper, Ed Gane, Catherine Stedman, Gail Matthews, Adrian Dunlop, Margaret Hellard, Ian Kronborg, David Shaw, Alain Litwin, Maria Christine Thurnheer, Martin Weltman, Philip Read, John Dillon, Simone Kessler, Cornelia Knapp, Lorenza Oprandi, Paola Messina, Marzia Pantic, Manuela Le Cam, Cecilia Maitre, Jessica Andreassen, Ingunn Melkeraaen, Merete Moen Tollefsen, Hannah Pagarigan, Rozalyn Milne, Kate Mason, Diana Kaznowski, Lily Zou, Rachel Bouchard, Barbara Kotsoros, Miriam Muir, Jessica Milloy, Victoria Oliver, Tracy Noonan, Alison Sevehon, Susan Hazelwood, Michelle Hall, Michelle Hagenauer, Rachel Liddle, Catherine Ferguson, Linda Agyemang, Hiral Patel, Irene Soloway, Orlando Cerocchi, Melanie Lacalamita, Vincenzo Fragomeli, Rosie Gilliver, Rebecca Lothian, Shirley Cleary, Linda Johnston, Sarah Middleton, Diana Brainard, John McHutchison

Affiliations

¹ The Kirby Institute, University of New South Wales, Sydney, Australia.
² Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
³ University of South Carolina-Greenville, Greenville, South Carolina, USA.
⁴ Clemson University, Greenville, South Carolina, USA.
⁵ Prisma Health, Greenville, South Carolina, USA.
⁶ Auckland City Hospital, Auckland, New Zealand.
⁷ Ottawa Hospital Research Institute, Ottawa, Canada.
⁸ Inserm UMR-S1136, Sorbonne Université, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France.
⁹ The Burnet Institute, Melbourne, Australia.
¹⁰ Department of Infectious Disease, The Alfred Hospital, Melbourne, Australia.
¹¹ Kirketon Road Centre, Sydney, Australia.
¹² South Riverdale Community Health Centre, Toronto, Canada.
¹³ Akershus University Hospital, Oslo, Norway.
¹⁴ Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
¹⁵ Centre Hospitalier de l'Université de Montréal, Montreal, Canada.
¹⁶ St Vincent's Hospital, Sydney, Australia.
¹⁷ Toronto General Hospital, Toronto, Canada.
¹⁸ Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom.
¹⁹ Royal Adelaide Hospital, Adelaide, Australia.
²⁰ Arud Centres for Addiction Medicine, Zurich, Switzerland.
²¹ Vancouver Infectious Diseases Center, Vancouver, Canada.
²² Coolaid Community Health Centre, Victoria, Canada.

PMID: 31677262
DOI: 10.1093/cid/ciz1089

Abstract

Background: This study investigated adherence and associated factors among people with recent injection drug use (IDU) or current opioid agonist therapy (OAT) and compared once-daily to twice-daily hepatitis C virus (HCV) direct-acting antiviral (DAA) therapy.

Methods: SIMPLIFY and D3FEAT are international, multicenter studies that recruited participants with recent IDU (previous 6 months; SIMPLIFY, D3FEAT) or current OAT (D3FEAT) between March 2016 and February 2017 in 8 countries. Participants received sofosbuvir/velpatasvir (once daily; SIMPLIFY) or paritaprevir/ritonavir/ombitasvir, dasabuvir (twice daily) ± ribavirin (D3FEAT) for 12 weeks administered in electronic blister packs. We evaluated overall adherence (proportion of prescribed doses taken) and nonadherence (<90% adherent) between dosing patterns.

Results: Of 190 participants, 184 (97%) completed treatment. Median adherence was 92%, with higher adherence among those receiving once-daily vs twice-daily therapy (94% vs 87%, P = .005). Overall, 40% of participants (n = 76) were nonadherent (<90% adherent). Recent stimulant injecting (odds ratio [OR], 2.48 [95% confidence interval {CI}, 1.28-4.82]), unstable housing (OR, 2.18 [95% CI, 1.01-4.70]), and twice-daily dosing (OR, 2.81 [95% CI, 1.47-5.36]) were associated with nonadherence. Adherence decreased during therapy. Sustained virologic response was high in nonadherent (89%) and adherent populations (95%, P = .174), with no difference in SVR between those who did and did not miss 7 consecutive doses (92% vs 93%, P = .897).

Conclusions: This study demonstrated high adherence to once- and twice-daily DAA therapy among people with recent IDU or currently receiving OAT. Nonadherence described did not impact treatment outcomes, suggesting forgiveness to nonadherence.

Keywords: HCV; OAT; PWID; injection drug users; treatment.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Analgesics, Opioid / therapeutic use
Anilides / therapeutic use
Antiviral Agents / therapeutic use
Drug Therapy, Combination
Hepacivirus
Hepatitis C* / drug therapy
Hepatitis C, Chronic* / drug therapy
Humans
Pharmaceutical Preparations*
Ribavirin / therapeutic use
Sustained Virologic Response

Substances

Analgesics, Opioid
Anilides
Antiviral Agents
Pharmaceutical Preparations
Ribavirin