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278 TREATMENT UPTAKE AND OUTCOMES AMONG CURRENT AND FORMER INJECTION DRUG USERS RECEIVING DIRECTLY OBSERVED THERAPY WITHIN A MULTIDISCIPLINARY GROUP MODEL FOR THE TREATMENT OF HEPATITIS C VIRUS INFECTION J Grebely1, F Duncan2, D Elliott2, M Khara2, A Mead2, M McLean2, L MacKenzie2, J Quesnelle2, N Suvorova2, JD Raffa3, M Viljoen2, S deVlaming2, B Conway1,2 Injection drug use accounts for the majority of incident and prevalent cases of hepatitis C virus (HCV) infection, however, very few injection drug users (IDUs) have received treatment. With this in mind, we sought to evaluate HCV treatment uptake and outcomes among current and former IDUs attending a weekly peer support group and receiving directly observed therapy.
1Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia; 2Pender Community Health Centre, Vancouver Coastal Health, Vancouver, Canada; 3Department of Statistics, University of Waterloo, Waterloo, Ontario
Subjects interested in receiving treatment for HCV infection were referred to a weekly peer-support group and evaluated for treatment. Patients had access to a multi-disciplinary care program including nurses, counselors, addiction specialists, infectious disease specialists and primary care physicians. Patients received therapy with pegylated interferon-alpha2a or -alpha2b, both in combination with ribavirin. All injections were directly observed.
Overall, we observed a high uptake of HCV treatment among attendees, with 51% either receiving or about to receive therapy. To date, 18 have initiated treatment for HCV infection and 12 have completed therapy. Of those treated, 56% (n=10) had reported illicit drug use in 6 months preceding therapy. Overall, 8/12 (75%) subjects achieved an end of treatment response (Genotype 1 - 67%, Genotypes 2/3 - 78%), despite ongoing drug use in 75% of patients during treatment. The median duration of therapy in individuals with genotypes 2/3 and genotype 1 was 14 and 28 weeks, respectively. In all patients having completed therapy for HCV infection (n=12), the mean directly observed adherence to interferon was 99.1%, while the mean self-reported adherence to ribavirin was 97.7%.
These data demonstrate that with the appropriate programs in place, a high uptake of HCV treatment can be achieved among IDUs referred to a peer-support group. Moreover, the treatment of HCV in current and former IDUs within a multidisciplinary DOT program can be successfully undertaken, resulting in ETRs similar to those in randomized controlled trials.