Evaluation of contingency management as a strategy to improve HCV linkage to care and treatment in persons attending needle and syringe programs: A pilot study

Evaluation of contingency management as a strategy to improve HCV linkage to care and treatment in persons attending needle and syringe programs: A pilot study

A greater proportion of HCV-infected people who inject drugs (PWID) need to be linked to care for HCV antiviral treatment. This study sets out to evaluate the efficacy of contingency management (CM) for improving HCV linkage to care, treatment initiation, adherence, and cure for PWID recruited from...

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Bibliographic Details
Published in:The International journal of drug policy Vol. 69; pp. 1 - 7
Main Authors: Norton, B.L., Bachhuber, M.A., Singh, R., Agyemang, L., Arnsten, J.H., Cunningham, C.O., Litwin, A.H.
Format: Journal Article
Language:English
Published: Netherlands Elsevier B.V 01-07-2019
Elsevier Science Ltd
Subjects:
Adherence
Adult
Antiviral Agents - therapeutic use
Antiviral drugs
Blister packs
Contingency learning
Contingency management
Cure
Demography
Drug policy
Drug Users - psychology
Drugs
Efficacy
Female
HCV
Hepatitis C
Hepatitis C - drug therapy
Humans
Intervention
Linkage to care
Male
Management
Medical treatment
Men
Middle Aged
Needle-Exchange Programs - trends
Needles
Patients
Persons who inject drugs (PWID)
Pilot Projects
Political appointments
Substance Abuse, Intravenous - complications
Substance Abuse, Intravenous - epidemiology
Syringe exchange programs
Syringes
Transportation
Treatment needs
HCV
Linkage to care
Contingency management
Persons who inject drugs (PWID)
Syringe exchange programs
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Summary:A greater proportion of HCV-infected people who inject drugs (PWID) need to be linked to care for HCV antiviral treatment. This study sets out to evaluate the efficacy of contingency management (CM) for improving HCV linkage to care, treatment initiation, adherence, and cure for PWID recruited from a needle and syringe program. Between March 2015 and April 2016, 20 participants were enrolled into the CM arm, and then subsequently enrolled 20 participants in the enhanced standard of care (eSOC) arm. Participants in the eSOC arm received an expedited appointment and a round-trip transit card. Participants enrolled in the CM arm received eSOC plus $25 for up to ten HCV clinical visits and $10 for each returned weekly medication blister pack. Adherence was measured via electronic blister packs. Overall the median age was 47 years; most were men (67%) and Hispanic (69%). There were no significant differences in demographic characteristics between participants in the study arms. In the CM arm 74% were linked to HCV care, compared to 30% in the eSOC arm (p = 0.01). In the CM arm, 75% (9/12) of treatment eligible participants initiated treatment, compared to 100%(4/4) in the eSOC arm (p = 0.53). All patients (9/9) achieved cure in the CM arm, as compared to 75% (3/4) of patients in the eSOC arm. There were no differences in adherence between study arms. In this pilot study, contingency management led to higher rates of HCV linkage to care for PWID, as compared to standard of care. CM should be considered as a possible intervention to improve the HCV treatment cascade for PWID.
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ISSN:0955-3959
1873-4758
1873-4758
DOI:10.1016/j.drugpo.2019.02.009