Hepatitis C care continuum and associated barriers among people who inject drugs in Chennai, India

Eshan U. Patel, Sunil Solomon, Allison McFall, Aylur K. Srikrishnan, Amrose Pradeep, Paneerselvam Nandagopal, Oliver B. Laeyendecker, Aaron A Tobian, David L Thomas, Mark Sulkowski, M. Suresh Kumar, Shruti Hemendra Mehta

Research output: Contribution to journalArticle

Abstract

Background: Little is known regarding barriers to hepatitis C virus (HCV) treatment among people who inject drugs (PWID) in low-resource settings, particularly in the era of direct-acting antiviral therapies. Methods: Between March, 2015–August, 2016, a cross-sectional survey was administered to community-based PWID in Chennai, India to examine the HCV care continuum and associated barriers. Adjusted prevalence ratios (APR) were estimated by multivariable Poisson regression with robust variance. Results: All participants were male (n = 541); 152 participants had HCV mono-infection and 61 participants had HIV/HCV co-infection. Only one HCV mono-infected and one HIV/HCV co-infected participant was linked to HCV care. Overall, there was moderate knowledge of HCV disease but poor knowledge of HCV treatment. Higher total knowledge scores were negatively associated with HIV/HCV co-infection (vs. HCV mono-infection), though this was not statistically significant in adjusted analysis (APR = 0.71 [95%CI = 0.47–1.06]). Participants ≥45 years (APR = 0.73 [95%CI = 0.58–0.92]) and participants with HIV/HCV co-infection (APR = 0.64 [95%CI = 0.47–0.87]) were less willing to take weekly interferon injections for 12 weeks. Willingness to undergo HCV treatment improved with decreasing duration of therapy, higher perceived efficacy, and use of pills vs. interferon, though willingness to use interferon improved with decreasing duration of therapy. Most participants preferred daily visits to a clinic for HCV treatment versus receiving a month's supply. Participants ≥45 years (vs. <45 years; APR = 0.70 [95%CI = 0.56–0.88]) and participants with HIV/HCV co-infection (APR = 0.75 [95%CI = 0.57–0.98]) were less likely to intend on seeking HCV care. Common reasons for not having already seen a provider for HCV treatment differed by HIV status, and included low perceived need for treatment (HCV-mono-infected), competing money/health priorities and costs/fears about treatment (HIV/HCV-co-infected). Conclusion: Residual gaps in HCV knowledge and continuing negative perceptions related to interferon-based therapy highlight the need to scale-up educational initiatives. Readiness for HCV treatment was particularly low among HIV/HCV co-infected and older PWID, emphasizing the importance of tailored treatment strategies.

Original languageEnglish (US)
Pages (from-to)51-60
Number of pages10
JournalInternational Journal of Drug Policy
Volume57
DOIs
StatePublished - Jul 1 2018

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Continuity of Patient Care
Hepatitis C
Hepacivirus
India
Pharmaceutical Preparations
Virus Diseases
HIV
Coinfection
Interferons
Therapeutics

Keywords

  • Direct acting antivirals
  • Hepatitis C
  • HIV
  • India
  • People who inject drugs
  • Treatment

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Health Policy

Cite this

Hepatitis C care continuum and associated barriers among people who inject drugs in Chennai, India. / Patel, Eshan U.; Solomon, Sunil; McFall, Allison; Srikrishnan, Aylur K.; Pradeep, Amrose; Nandagopal, Paneerselvam; Laeyendecker, Oliver B.; Tobian, Aaron A; Thomas, David L; Sulkowski, Mark; Kumar, M. Suresh; Mehta, Shruti Hemendra.

In: International Journal of Drug Policy, Vol. 57, 01.07.2018, p. 51-60.

Research output: Contribution to journalArticle

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abstract = "Background: Little is known regarding barriers to hepatitis C virus (HCV) treatment among people who inject drugs (PWID) in low-resource settings, particularly in the era of direct-acting antiviral therapies. Methods: Between March, 2015–August, 2016, a cross-sectional survey was administered to community-based PWID in Chennai, India to examine the HCV care continuum and associated barriers. Adjusted prevalence ratios (APR) were estimated by multivariable Poisson regression with robust variance. Results: All participants were male (n = 541); 152 participants had HCV mono-infection and 61 participants had HIV/HCV co-infection. Only one HCV mono-infected and one HIV/HCV co-infected participant was linked to HCV care. Overall, there was moderate knowledge of HCV disease but poor knowledge of HCV treatment. Higher total knowledge scores were negatively associated with HIV/HCV co-infection (vs. HCV mono-infection), though this was not statistically significant in adjusted analysis (APR = 0.71 [95{\%}CI = 0.47–1.06]). Participants ≥45 years (APR = 0.73 [95{\%}CI = 0.58–0.92]) and participants with HIV/HCV co-infection (APR = 0.64 [95{\%}CI = 0.47–0.87]) were less willing to take weekly interferon injections for 12 weeks. Willingness to undergo HCV treatment improved with decreasing duration of therapy, higher perceived efficacy, and use of pills vs. interferon, though willingness to use interferon improved with decreasing duration of therapy. Most participants preferred daily visits to a clinic for HCV treatment versus receiving a month's supply. Participants ≥45 years (vs. <45 years; APR = 0.70 [95{\%}CI = 0.56–0.88]) and participants with HIV/HCV co-infection (APR = 0.75 [95{\%}CI = 0.57–0.98]) were less likely to intend on seeking HCV care. Common reasons for not having already seen a provider for HCV treatment differed by HIV status, and included low perceived need for treatment (HCV-mono-infected), competing money/health priorities and costs/fears about treatment (HIV/HCV-co-infected). Conclusion: Residual gaps in HCV knowledge and continuing negative perceptions related to interferon-based therapy highlight the need to scale-up educational initiatives. Readiness for HCV treatment was particularly low among HIV/HCV co-infected and older PWID, emphasizing the importance of tailored treatment strategies.",
keywords = "Direct acting antivirals, Hepatitis C, HIV, India, People who inject drugs, Treatment",
author = "Patel, {Eshan U.} and Sunil Solomon and Allison McFall and Srikrishnan, {Aylur K.} and Amrose Pradeep and Paneerselvam Nandagopal and Laeyendecker, {Oliver B.} and Tobian, {Aaron A} and Thomas, {David L} and Mark Sulkowski and Kumar, {M. Suresh} and Mehta, {Shruti Hemendra}",
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T1 - Hepatitis C care continuum and associated barriers among people who inject drugs in Chennai, India

AU - Patel, Eshan U.

AU - Solomon, Sunil

AU - McFall, Allison

AU - Srikrishnan, Aylur K.

AU - Pradeep, Amrose

AU - Nandagopal, Paneerselvam

AU - Laeyendecker, Oliver B.

AU - Tobian, Aaron A

AU - Thomas, David L

AU - Sulkowski, Mark

AU - Kumar, M. Suresh

AU - Mehta, Shruti Hemendra

PY - 2018/7/1

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N2 - Background: Little is known regarding barriers to hepatitis C virus (HCV) treatment among people who inject drugs (PWID) in low-resource settings, particularly in the era of direct-acting antiviral therapies. Methods: Between March, 2015–August, 2016, a cross-sectional survey was administered to community-based PWID in Chennai, India to examine the HCV care continuum and associated barriers. Adjusted prevalence ratios (APR) were estimated by multivariable Poisson regression with robust variance. Results: All participants were male (n = 541); 152 participants had HCV mono-infection and 61 participants had HIV/HCV co-infection. Only one HCV mono-infected and one HIV/HCV co-infected participant was linked to HCV care. Overall, there was moderate knowledge of HCV disease but poor knowledge of HCV treatment. Higher total knowledge scores were negatively associated with HIV/HCV co-infection (vs. HCV mono-infection), though this was not statistically significant in adjusted analysis (APR = 0.71 [95%CI = 0.47–1.06]). Participants ≥45 years (APR = 0.73 [95%CI = 0.58–0.92]) and participants with HIV/HCV co-infection (APR = 0.64 [95%CI = 0.47–0.87]) were less willing to take weekly interferon injections for 12 weeks. Willingness to undergo HCV treatment improved with decreasing duration of therapy, higher perceived efficacy, and use of pills vs. interferon, though willingness to use interferon improved with decreasing duration of therapy. Most participants preferred daily visits to a clinic for HCV treatment versus receiving a month's supply. Participants ≥45 years (vs. <45 years; APR = 0.70 [95%CI = 0.56–0.88]) and participants with HIV/HCV co-infection (APR = 0.75 [95%CI = 0.57–0.98]) were less likely to intend on seeking HCV care. Common reasons for not having already seen a provider for HCV treatment differed by HIV status, and included low perceived need for treatment (HCV-mono-infected), competing money/health priorities and costs/fears about treatment (HIV/HCV-co-infected). Conclusion: Residual gaps in HCV knowledge and continuing negative perceptions related to interferon-based therapy highlight the need to scale-up educational initiatives. Readiness for HCV treatment was particularly low among HIV/HCV co-infected and older PWID, emphasizing the importance of tailored treatment strategies.

AB - Background: Little is known regarding barriers to hepatitis C virus (HCV) treatment among people who inject drugs (PWID) in low-resource settings, particularly in the era of direct-acting antiviral therapies. Methods: Between March, 2015–August, 2016, a cross-sectional survey was administered to community-based PWID in Chennai, India to examine the HCV care continuum and associated barriers. Adjusted prevalence ratios (APR) were estimated by multivariable Poisson regression with robust variance. Results: All participants were male (n = 541); 152 participants had HCV mono-infection and 61 participants had HIV/HCV co-infection. Only one HCV mono-infected and one HIV/HCV co-infected participant was linked to HCV care. Overall, there was moderate knowledge of HCV disease but poor knowledge of HCV treatment. Higher total knowledge scores were negatively associated with HIV/HCV co-infection (vs. HCV mono-infection), though this was not statistically significant in adjusted analysis (APR = 0.71 [95%CI = 0.47–1.06]). Participants ≥45 years (APR = 0.73 [95%CI = 0.58–0.92]) and participants with HIV/HCV co-infection (APR = 0.64 [95%CI = 0.47–0.87]) were less willing to take weekly interferon injections for 12 weeks. Willingness to undergo HCV treatment improved with decreasing duration of therapy, higher perceived efficacy, and use of pills vs. interferon, though willingness to use interferon improved with decreasing duration of therapy. Most participants preferred daily visits to a clinic for HCV treatment versus receiving a month's supply. Participants ≥45 years (vs. <45 years; APR = 0.70 [95%CI = 0.56–0.88]) and participants with HIV/HCV co-infection (APR = 0.75 [95%CI = 0.57–0.98]) were less likely to intend on seeking HCV care. Common reasons for not having already seen a provider for HCV treatment differed by HIV status, and included low perceived need for treatment (HCV-mono-infected), competing money/health priorities and costs/fears about treatment (HIV/HCV-co-infected). Conclusion: Residual gaps in HCV knowledge and continuing negative perceptions related to interferon-based therapy highlight the need to scale-up educational initiatives. Readiness for HCV treatment was particularly low among HIV/HCV co-infected and older PWID, emphasizing the importance of tailored treatment strategies.

KW - Direct acting antivirals

KW - Hepatitis C

KW - HIV

KW - India

KW - People who inject drugs

KW - Treatment

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