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Treatment Adherence and Support for People who Inject Drugs Taking Direct Acting Antiviral Therapy for Hepatitis C Infection.

08:00 EDT 12th July 2019 | BioPortfolio

Summary of "Treatment Adherence and Support for People who Inject Drugs Taking Direct Acting Antiviral Therapy for Hepatitis C Infection."

A community-based public health facility in Sydney, Australia, the Kirketon Road Centre (KRC) provides healthcare to people who inject drugs (PWID), homeless and other marginalised people. Since March 2016, KRC has provided treatment for chronic hepatitis C virus (HCV) with direct acting antivirals (DAAs). We aimed to evaluate treatment adherence amongst clients taking DAAs in a highly marginalised population. All clients who commenced DAA therapy prior to March 2018 at KRC were included in this observational cohort with a subset of clients attending daily or weekly for enhanced adherence support and dosing. Demographic, behavioural, clinical measures and medication dosing was recorded and adherence calculated as the proportion of doses taken during the expected treatment duration. Factors associated with adherence were examined using logistic regression. 242 individuals commenced DAA therapy, of whom 79 (32%) received enhanced adherence support. Enhanced support was associated with homelessness, daily injecting, Aboriginality, mental health co-morbidity and poly-drug use (all p<0.001). Overall adherence was 86%, and 92% of patients missed one or more doses (median 10, IQR 4-24). At least 90% adherence during planned duration was seen in 38%, but increased to 66% by continuing therapy beyond planned duration. Intention-to-treat SVR12 was 68%, and 66% in the enhanced adherence support sub-population, with 29% lost-to-follow up by SVR12 testing. There were only 2 (0.8%) documented virological failures. Per-protocol SVR12 was 99%, and 96% in the enhanced adherence support sub-population. In conclusion, adherence support may benefit those with multiple markers of marginalisation. Extension of therapy beyond planned duration is a pragmatic strategy to enhance completion. Strategies to improve follow-up, particularly post-treatment are required. This article is protected by copyright. All rights reserved.

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This article was published in the following journal.

Name: Journal of viral hepatitis
ISSN: 1365-2893
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Medical and Biotech [MESH] Definitions

Voluntary cooperation of the patient in taking drugs or medicine as prescribed. This includes timing, dosage, and frequency.

Extent to which the patient follows prescribed treatment such as keeping APPOINTMENTS AND SCHEDULES and MEDICATION ADHERENCE for desired therapeutic outcome. It implies active responsibility shared by patient and health care providers.

Drugs which have received FDA approval for human testing but have yet to be approved for commercial marketing. This includes drugs used for treatment while they still are undergoing clinical trials (Treatment IND). The main heading includes drugs under investigation in foreign countries.

Fluid propulsion systems driven mechanically, electrically, or osmotically that are used to inject (or infuse) over time agents into a patient or experimental animal; used routinely in hospitals to maintain a patent intravenous line, to administer antineoplastic agents and other drugs in thromboembolism, heart disease, diabetes mellitus (INSULIN INFUSION SYSTEMS is also available), and other disorders.

Compliance by health personnel or proxies with the stipulations of ADVANCE DIRECTIVES (or similar directives such as RESUSCITATION ORDERS) when patients are unable to direct their own care.

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