Adherence Support Needed for Drug Users on Hepatitis C Antivirals

Researchers have identified several factors that could facilitate treatment adherence for patients infected with hepatitis C virus (HCV) who are also people who inject drugs (PWID).

Their findings are described in a paper by Zachary Rich, a medical student, of the UNC Project China at the Guangdong Provincial Dermatovenerology Hospital in Guangdong Province, and colleagues, which was published in BMC Public Health on September 20, 2016. Direct acting antiviral (DAA) drugs are changing the way that HCV infection is treated around the world However, for DAAs to be effective, a high level of adherence is required.

The researchers say, “Given the disproportionately high burden of disease among PWIDs, it is imperative that they are included in DAA scale-up programs and achieve high levels of adherence.” They add, “The purpose of this systematic review is to evaluate qualitative studies investigating facilitators to HCV treatment adherence among PWID.”

The authors identified 10 studies which met their predefined criteria for inclusion. All 10 were conducted in high-income countries and “represent data from 525 participants and were conducted through in-depth interviews,” report the researchers.

Several dominant themes emerged, with the first being logistical support. The researchers say, “Many patients expressed that their complex financial and medical needs must concurrently be accounted for in order to maintain high levels of adherence.”

These needs include everything from getting to and from clinics to help in finding jobs. Transportation was a frequent barrier to adherence. The researchers suggest that integration of services is one way to facilitate adherence.

The next major theme is that patients need to have positive interactions with the support system overall. The relationships between patients and providers are critical.

The researchers say, “Providers who expressed concern and understanding gained the trust of patients to withstand treatment and made the side effects of the interferon more manageable.”

In addition to support from staff, support from peers raised levels of adherence. Finally, the researchers found that sobriety was the primary goal for PWID and treatment for HCV was secondary. Clinics which support those goals, in that order, help patients develop a new, healthier identity and raised treatment adherence.

The authors conclude, “Our review highlights the need for more qualitative research on hepatitis C service delivery among PWID,” adding, “some of the evidence gathered from delivering HIV services to PWID may be able to inform the development of high quality HCV services for PWID.”

The authors did not address an issue that is controversial in the US and some other countries: policies that preclue active injection drug users from getting DAAs.