Patterns of Drug and 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

Abstract

Background: In many settings, recent or prior injection drug use remains a barrier to accessing direct-acting antiviral treatment (DAA) for hepatitis C virus (HCV) infection. We examined 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 4 trials evaluating the efficacy of DAA among people with past 6-month injecting drug use or receiving OAT through a network of 25 international sites. Enrolled in 2016-2017, participants received sofosbuvir/velpatasvir (SIMPLIFY) or paritaprevir/ritonavir/dasabuvir/ombitasvir ± ribavirin (D3FEAT) for 12 weeks and completed behavioral questionnaires before, during, and up to 2 years posttreatment. The impact of time in HCV treatment and follow-up on longitudinally measured longitudinally measured behaviors was estimated using generalized estimating equations.

Results: At screening, of 190 participants (mean age, 47 years; 74% male), 62% reported any past-month injecting 16% past-month injection equipment sharing, and 61% current OAT. Median alcohol use was 2 (Alcohol Use Disorders Identification Test-Consumption; range, 1-12). During follow-up, opioid injecting (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.92-0.99) and sharing (OR, 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).

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

Clinical trials registration: SIMPLIFY, NCT02336139; D3FEAT, NCT02498015.

Keywords: DAA; PWID; drug use; hepatitis C; injecting drug use.

Figure 1.

Proportion of participants reporting injecting drug use and sharing of injection equipment (A), median alcohol use (B), and proportion receiving opioid agonist treatment (OAT) and noninjecting drugs (C) at each visit, during and following direct-acting antiviral treatment for hepatitis C virus infection among people with recent injection drug use or receiving OAT recruited and followed in SIMPLIFY and D3FEAT (N = 190). Drug use outcomes and OAT refer to the past month and current period, respectively. Baseline visit refers to the date of treatment initiation. Follow-up periods 1, 2, and 3 correspond to weeks 60, 84, and 108 since treatment initiation, respectively. At screening, the sample size was 188 rather than 190 because behavioral data were unavailable for 2 participants recruited in D3FEAT. Abbreviations: BL, baseline; ETR, end of treatment; FU, follow-up; SCR, screening; SVR, sustained virological response; W, week.

Figure 2.

Trajectories of behavioral outcomes during and following direct-acting antiviral treatment for hepatitis C virus infection among people with recent injection drug use or receiving opioid agonist treatment recruited and followed in SIMPLIFY and D3FEAT (N = 190). Solid lines represent the estimated probability of each behavioral outcome for each group, and dashed lines represent 95% confidence intervals. Behaviors refer to the past month period. Baseline visit refers to the date of treatment initiation. Follow-up periods 1, 2, and 3 correspond to weeks 60, 84, and 108 since treatment initiation, respectively. At screening, the sample size was 188 rather than 190 because behavioral data were unavailable for 2 participants recruited in D3FEAT. Example of interpretation: for stimulant injecting, 22% of participants injected stimulants at nearly all visits, 18% oscillated between injecting and noninjecting patterns, and 60% never injected. Abbreviations: BL, baseline; AUDIT-C, Alcohol Use Disorders Identification Test–Consumption; BL, baseline; ETR, end of treatment; FU, follow-up; SCR, screening; SVR, sustained virological response; W, week.