Hepatitis C diagnosis and treatment, impact on engagement and behaviour of people who inject drugs, a service evaluation, the hooked C project

There is emerging evidence that Hepatitis C (HCV) treatment engagement is associated with change in drug behaviours and reduced drug‐related death rates among people who inject drugs (PWID). The project aims to investigate whether HCV diagnosis and treatment engagement reduces all‐cause mortality an...

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Bibliographic Details
Published in:	Journal of viral hepatitis Vol. 27; no. 6; pp. 576 - 584
Main Authors:	Caven, Madeleine, Robinson, Emma M., Eriksen, Ann J., Fletcher, Emma H., Dillon, John F.
Format:	Journal Article
Language:	English
Published:	England Wiley Subscription Services, Inc 01-06-2020
Subjects:	Antiviral agents case‐control studies Death Diagnosis Drug development drug‐related death Hepatitis Hepatitis C injecting behaviour Interferon Medical diagnosis Mortality people who inject drugs drug-related death hepatitis C injecting behaviour people who inject drugs case-control studies
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Summary:	There is emerging evidence that Hepatitis C (HCV) treatment engagement is associated with change in drug behaviours and reduced drug‐related death rates among people who inject drugs (PWID). The project aims to investigate whether HCV diagnosis and treatment engagement reduces all‐cause mortality and drug‐related death, and whether any effect is dependent on treatment regimen and intensity of engagement with staff. Case‐control studies comparing: PWID with active HCV infection (PCR positive) to PWID HCV infected but spontaneously resolved (PCR negative); PCR‐positive patients who engaged with treatment services to nonengagers; and patients who received interferon vs direct‐acting antiviral (DAA) based treatment. No differences in risk of all‐cause mortality or drug‐related death between PCR‐negative controls and PCR‐positive cases were detected. The odds of all‐cause mortality was 12.2 times higher in nonengaging persons compared to treatment engaging cases (aOR 12.15, 95% CI 7.03‐20.99, P < .001). The odds of a drug‐related death were 5.5 times higher in nonengaging persons compared with treatment engaging cases (aOR 5.52, 95% CI 2.67‐ 11.44, P < .001). No differences in risk of all‐cause mortality or drug‐related death between interferon‐treated cases and DAA‐treated controls were detected. HCV treatment engagement is significantly protective against all‐cause mortality and drug‐related death. This engagement effect is independent of treatment regimen, with the introduction of DAA therapies not increasing risk of drug‐related death, suggesting intensity of HCV therapy provider interaction is not an important factor.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1352-0504 1365-2893
DOI:	10.1111/jvh.13269