Implementing and Scaling Up HCV Treatment Services for People Who Inject Drugs and Other High Risk Groups in Ukraine: An Evaluation of Programmatic and Treatment Outcomes

Overview

Journal Int J Drug Policy

Publisher Elsevier

Specialties Psychiatry
Public Health

Date 2017 Aug 17

PMID 28811159

Citations 13

Authors

Alyona Mazhnaya

Anna Meteliuk

Tetiana Barnard

Alexei Zelenev

Sergii Filippovych

Frederick L Altice

Affiliations

Soon will be listed here.

Abstract

Background: HCV prevalence estimates among people who inject drugs (PWID) in Ukraine is high (60-90%), yet barriers to HCV treatment and care remain substantial including limited access to direct acting antiviral (DAA) medications. A feasibility scale-up project implemented HCV treatment in community-based settings to improve access to DAA treatment for key populations in this context.

Methods: Using program-level data and verified medical records, we describe the development, implementation processes and outcomes for HCV treatment for PWID and other risks groups. Most participants (76%) received a combination of sofosbuvir, pegylated interferon, and ribavirin for 12 weeks. Treatment enrollment started in June 2015; the first two waves are reported. Data on demographics, HIV characteristics, HCV genotype and RNA levels, including sustained virologic response (SVR) were obtained from verified medical records. We used logistic regression to examine the independent correlates of achieving a SVR.

Results: The project was implemented in 19 healthcare institutions from 16 regions of Ukraine, mainly within AIDS specialty centers. Our analytical sample included 1126 participants who were mostly men (73%) and the majority were HIV co-infected (79%). Treatment retention was 97.7%; the proportions of participants who achieved SVR for the overall sample and for those with complete data (N=1029) were 86.2% (95% CI 84.08-88.19%) and 94.3% (95% CI 92.8-95.7%) respectively. The analysis of data restricted to only those with SVR data available showed that PWID who were currently injecting had comparable SVR rates (89.2%, 95% CI 81.5-94.5%) to PWID not injecting (94.4%, 95% CI 92.4-96.1), PWID on methadone (94.4%, 95%CI 92.4-96.1), and 'other' risk groups (95.2%, 95% CI 91.3-97.7). Independent factors associated with achieving a SVR were female sex (AOR: 3.44, 95% CI 1.45-8.14), HCV genotype 3 (AOR: 4.57, 95% CI 1.97-10.59) compared to genotype 1. SVR rates in PWID actively injecting did not differ significantly from any other group.

Conclusion: Both patient-level and structural factors influence HCV treatment scale-up in Ukraine, but patient-level outcomes confirm high levels of achieving SVR in PWID, irrespective of injection and treatment status.

Citing Articles

Hepatitis C Virus in people with experience of injection drug use following their displacement to Southern Ukraine before 2020.

Yakovleva A, Kovalenko G, Redlinger M, Smyrnov P, Tymets O, Korobchuk A BMC Infect Dis. 2023; 23(1):446.

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Predictors of hepatitis C cure among people who inject drugs treated with directly observed therapy supported by peer case managers in Kenya.

Akiyama M, Riback L, Nyakowa M, Musyoki H, Lizcano J, Muller A Int J Drug Policy. 2023; 113:103959.

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Nurse Practitioner-Led Integrated Rapid Access to HIV Prevention for People Who Inject Drugs (iRaPID): Protocol for a Pilot Randomized Controlled Trial.

Khati A, Altice F, Vlahov D, Eger W, Lee J, Bohonnon T JMIR Res Protoc. 2022; 11(10):e42585.

PMID: 36222826 PMC: 9597427. DOI: 10.2196/42585.

Potential interventions to support HCV treatment uptake among HIV co-infected people in Canada: Perceptions of patients and health care providers.

Ortiz-Paredes D, Amoako A, Lessard D, Engler K, Lebouche B, Klein M Can Liver J. 2022; 5(1):14-30.

PMID: 35990783 PMC: 9231425. DOI: 10.3138/canlivj-2021-0021.

Diagnosis and treatment of hepatitis C virus infection: a tool for engagement with people who inject drugs in Vancouver's Downtown Eastside.

Alimohammadi A, Holeksa J, Parsons R, Yung R, Amiri N, Truong D Can Liver J. 2022; 1(2):14-33.

PMID: 35990714 PMC: 9202795. DOI: 10.3138/canlivj.1.2.002.

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