Predictors of Hepatitis C Cure among People Who Inject Drugs Treated with Directly Observed Therapy supported by Peer Case Managers in Kenya

Matthew Akiyama; Lindsey Riback; Mercy Nyakowa; Helgar Musyoki; John Lizcano; Abbe Muller; Chenshu Zhang; Josephine G Walker; Jack Stone; Peter T Vickerman; Peter Cherutich; Ann Kurth

doi:10.1016/j.drugpo.2023.103959

Predictors of Hepatitis C Cure among People Who Inject Drugs Treated with Directly Observed Therapy supported by Peer Case Managers in Kenya

Matthew Akiyama^*
, Lindsey Riback
, Mercy Nyakowa
, Helgar Musyoki
, John Lizcano
, Abbe Muller
, Chenshu Zhang
, Josephine G Walker
, Jack Stone
, Peter T Vickerman
, Peter Cherutich
, Ann Kurth

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

6 Citations (Scopus)

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Abstract

Background & Aims
Directly observed therapy (DOT) maximizes adherence and minimizes treatment gaps. Peer case managers (PCM) have also shown promise as a component of integrated HCV treatment strategies. DOT and PCM-support have been underexplored, particularly in low- and middle-income countries (LMICs). The objective of this study was to evaluate predictors of sustained virologic response (SVR) among people who inject drugs (PWID) attending medication-assisted treatment (MAT) and needle and syringe programs (NSP) sites in Kenya.

Methods
We recruited PWID accessing MAT and NSP in Nairobi and Coastal Kenya. PWID were treated with ledipasvir/sofosbuvir using DOT supported by PCMs. We used bivariate and multivariate logistic regression to examine the impact of sociodemographic, behavioral, and clinical factors on SVR.

Results
Among 92 PWID who initiated HCV treatment, 79 (86%) were male with mean age of 36.3 years (SD=±6.5); 38 (41%) were HIV-positive, and 87 (95%) reported injecting drugs in the last 30 days. Just over half of participants were genotype 1a (55%), followed by genotype 4a (41%) and mixed 1a/4a (3%). Most participants, 85 (92%) completed treatment and 79 (86%) achieved SVR. While sociodemographic and behavioral factors including recent injection drug use were not significantly associated with achieving SVR, being fully adherent (p=0.042), number of doses taken (p=0.008) and treatment completion (p= 0.001) were associated with higher odds of achieving SVR.

Conclusions
DOT with PCM-support was an effective model for HCV treatment among PWID in this LMIC setting. Adherence was the most important driver of SVR suggesting DOT and PCM support can overcome other factors that might limit adherence. Further research is necessary to ascertain the effectiveness of other models of HCV care for PWID in LMICs given NSP and MAT access is variable, and DOT may not be sustainable with limited resources.

Original language	English
Article number	103959
Pages (from-to)	1-8
Journal	International Journal of Drug Policy
Volume	113
Early online date	7 Feb 2023
DOIs	https://doi.org/10.1016/j.drugpo.2023.103959
Publication status	Published - 1 Mar 2023

Bibliographical note

Funding Information:
This research was supported by the National Institute On Drug Abuse (NIDA) of the National Institutes of Health (NIH) under Award Number R01DA032080 (awarded to principal investigators AEK and PC) and a pilot grant from the Albert Einstein Global Health Center (awarded to principal investigator MJA). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The sponsor had no role in study design, data collection, data analysis, data interpretation, or writing of the report. Dr. Akiyama is also supported by grants from NIDA R00 DA043011, DP2 DA053730, and the National Institute on Minority Health and Health Disparities (NIMHD) R01MD016744.

Funding Information:
We gratefully acknowledge the Centers for Disease Control and Prevention, Division of Viral Hepatitis (Atlanta, GA, USA) for assistance in genotyping the specimens obtained in this study; Kenya National Blood Transfusion Services (Nairobi, Mombasa, Malindi, and Kisumu, Kenya) for assistance in plasma separation; and the Kenya Medical Research Institute (Kisumu, Kenya) for assistance with HCV RNA confirmatory tests. We also thank Martin Sirengo, Janet Muriithi, Emily Juma, and the research assistants at the National AIDS & STI Control Program for their contributions and support, as well as National Institute on Drug Abuse Project Officer Dionne Jones for her support.

Publisher Copyright:
© 2023 Elsevier B.V.

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Akiyama, M., Riback, L., Nyakowa, M., Musyoki, H., Lizcano, J., Muller, A., Zhang, C., Walker, J. G., Stone, J., Vickerman, P. T., Cherutich, P., & Kurth, A. (2023). Predictors of Hepatitis C Cure among People Who Inject Drugs Treated with Directly Observed Therapy supported by Peer Case Managers in Kenya. International Journal of Drug Policy, 113, 1-8. Article 103959. https://doi.org/10.1016/j.drugpo.2023.103959

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title = "Predictors of Hepatitis C Cure among People Who Inject Drugs Treated with Directly Observed Therapy supported by Peer Case Managers in Kenya",

abstract = "Background \& Aims Directly observed therapy (DOT) maximizes adherence and minimizes treatment gaps. Peer case managers (PCM) have also shown promise as a component of integrated HCV treatment strategies. DOT and PCM-support have been underexplored, particularly in low- and middle-income countries (LMICs). The objective of this study was to evaluate predictors of sustained virologic response (SVR) among people who inject drugs (PWID) attending medication-assisted treatment (MAT) and needle and syringe programs (NSP) sites in Kenya. Methods We recruited PWID accessing MAT and NSP in Nairobi and Coastal Kenya. PWID were treated with ledipasvir/sofosbuvir using DOT supported by PCMs. We used bivariate and multivariate logistic regression to examine the impact of sociodemographic, behavioral, and clinical factors on SVR. Results Among 92 PWID who initiated HCV treatment, 79 (86\%) were male with mean age of 36.3 years (SD=±6.5); 38 (41\%) were HIV-positive, and 87 (95\%) reported injecting drugs in the last 30 days. Just over half of participants were genotype 1a (55\%), followed by genotype 4a (41\%) and mixed 1a/4a (3\%). Most participants, 85 (92\%) completed treatment and 79 (86\%) achieved SVR. While sociodemographic and behavioral factors including recent injection drug use were not significantly associated with achieving SVR, being fully adherent (p=0.042), number of doses taken (p=0.008) and treatment completion (p= 0.001) were associated with higher odds of achieving SVR. Conclusions DOT with PCM-support was an effective model for HCV treatment among PWID in this LMIC setting. Adherence was the most important driver of SVR suggesting DOT and PCM support can overcome other factors that might limit adherence. Further research is necessary to ascertain the effectiveness of other models of HCV care for PWID in LMICs given NSP and MAT access is variable, and DOT may not be sustainable with limited resources.",

author = "Matthew Akiyama and Lindsey Riback and Mercy Nyakowa and Helgar Musyoki and John Lizcano and Abbe Muller and Chenshu Zhang and Walker, \{Josephine G\} and Jack Stone and Vickerman, \{Peter T\} and Peter Cherutich and Ann Kurth",

note = "Funding Information: This research was supported by the National Institute On Drug Abuse (NIDA) of the National Institutes of Health (NIH) under Award Number R01DA032080 (awarded to principal investigators AEK and PC) and a pilot grant from the Albert Einstein Global Health Center (awarded to principal investigator MJA). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The sponsor had no role in study design, data collection, data analysis, data interpretation, or writing of the report. Dr. Akiyama is also supported by grants from NIDA R00 DA043011, DP2 DA053730, and the National Institute on Minority Health and Health Disparities (NIMHD) R01MD016744. Funding Information: We gratefully acknowledge the Centers for Disease Control and Prevention, Division of Viral Hepatitis (Atlanta, GA, USA) for assistance in genotyping the specimens obtained in this study; Kenya National Blood Transfusion Services (Nairobi, Mombasa, Malindi, and Kisumu, Kenya) for assistance in plasma separation; and the Kenya Medical Research Institute (Kisumu, Kenya) for assistance with HCV RNA confirmatory tests. We also thank Martin Sirengo, Janet Muriithi, Emily Juma, and the research assistants at the National AIDS \& STI Control Program for their contributions and support, as well as National Institute on Drug Abuse Project Officer Dionne Jones for her support. Publisher Copyright: {\textcopyright} 2023 Elsevier B.V.",

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doi = "10.1016/j.drugpo.2023.103959",

language = "English",

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Akiyama, M, Riback, L, Nyakowa, M, Musyoki, H, Lizcano, J, Muller, A, Zhang, C, Walker, JG , Stone, J , Vickerman, PT, Cherutich, P & Kurth, A 2023, 'Predictors of Hepatitis C Cure among People Who Inject Drugs Treated with Directly Observed Therapy supported by Peer Case Managers in Kenya', International Journal of Drug Policy, vol. 113, 103959, pp. 1-8. https://doi.org/10.1016/j.drugpo.2023.103959

TY - JOUR

T1 - Predictors of Hepatitis C Cure among People Who Inject Drugs Treated with Directly Observed Therapy supported by Peer Case Managers in Kenya

AU - Akiyama, Matthew

AU - Riback, Lindsey

AU - Nyakowa, Mercy

AU - Musyoki, Helgar

AU - Lizcano, John

AU - Muller, Abbe

AU - Zhang, Chenshu

AU - Walker, Josephine G

AU - Stone, Jack

AU - Vickerman, Peter T

AU - Cherutich, Peter

AU - Kurth, Ann

N1 - Funding Information: This research was supported by the National Institute On Drug Abuse (NIDA) of the National Institutes of Health (NIH) under Award Number R01DA032080 (awarded to principal investigators AEK and PC) and a pilot grant from the Albert Einstein Global Health Center (awarded to principal investigator MJA). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The sponsor had no role in study design, data collection, data analysis, data interpretation, or writing of the report. Dr. Akiyama is also supported by grants from NIDA R00 DA043011, DP2 DA053730, and the National Institute on Minority Health and Health Disparities (NIMHD) R01MD016744. Funding Information: We gratefully acknowledge the Centers for Disease Control and Prevention, Division of Viral Hepatitis (Atlanta, GA, USA) for assistance in genotyping the specimens obtained in this study; Kenya National Blood Transfusion Services (Nairobi, Mombasa, Malindi, and Kisumu, Kenya) for assistance in plasma separation; and the Kenya Medical Research Institute (Kisumu, Kenya) for assistance with HCV RNA confirmatory tests. We also thank Martin Sirengo, Janet Muriithi, Emily Juma, and the research assistants at the National AIDS & STI Control Program for their contributions and support, as well as National Institute on Drug Abuse Project Officer Dionne Jones for her support. Publisher Copyright: © 2023 Elsevier B.V.

PY - 2023/3/1

Y1 - 2023/3/1

N2 - Background & Aims Directly observed therapy (DOT) maximizes adherence and minimizes treatment gaps. Peer case managers (PCM) have also shown promise as a component of integrated HCV treatment strategies. DOT and PCM-support have been underexplored, particularly in low- and middle-income countries (LMICs). The objective of this study was to evaluate predictors of sustained virologic response (SVR) among people who inject drugs (PWID) attending medication-assisted treatment (MAT) and needle and syringe programs (NSP) sites in Kenya. Methods We recruited PWID accessing MAT and NSP in Nairobi and Coastal Kenya. PWID were treated with ledipasvir/sofosbuvir using DOT supported by PCMs. We used bivariate and multivariate logistic regression to examine the impact of sociodemographic, behavioral, and clinical factors on SVR. Results Among 92 PWID who initiated HCV treatment, 79 (86%) were male with mean age of 36.3 years (SD=±6.5); 38 (41%) were HIV-positive, and 87 (95%) reported injecting drugs in the last 30 days. Just over half of participants were genotype 1a (55%), followed by genotype 4a (41%) and mixed 1a/4a (3%). Most participants, 85 (92%) completed treatment and 79 (86%) achieved SVR. While sociodemographic and behavioral factors including recent injection drug use were not significantly associated with achieving SVR, being fully adherent (p=0.042), number of doses taken (p=0.008) and treatment completion (p= 0.001) were associated with higher odds of achieving SVR. Conclusions DOT with PCM-support was an effective model for HCV treatment among PWID in this LMIC setting. Adherence was the most important driver of SVR suggesting DOT and PCM support can overcome other factors that might limit adherence. Further research is necessary to ascertain the effectiveness of other models of HCV care for PWID in LMICs given NSP and MAT access is variable, and DOT may not be sustainable with limited resources.

AB - Background & Aims Directly observed therapy (DOT) maximizes adherence and minimizes treatment gaps. Peer case managers (PCM) have also shown promise as a component of integrated HCV treatment strategies. DOT and PCM-support have been underexplored, particularly in low- and middle-income countries (LMICs). The objective of this study was to evaluate predictors of sustained virologic response (SVR) among people who inject drugs (PWID) attending medication-assisted treatment (MAT) and needle and syringe programs (NSP) sites in Kenya. Methods We recruited PWID accessing MAT and NSP in Nairobi and Coastal Kenya. PWID were treated with ledipasvir/sofosbuvir using DOT supported by PCMs. We used bivariate and multivariate logistic regression to examine the impact of sociodemographic, behavioral, and clinical factors on SVR. Results Among 92 PWID who initiated HCV treatment, 79 (86%) were male with mean age of 36.3 years (SD=±6.5); 38 (41%) were HIV-positive, and 87 (95%) reported injecting drugs in the last 30 days. Just over half of participants were genotype 1a (55%), followed by genotype 4a (41%) and mixed 1a/4a (3%). Most participants, 85 (92%) completed treatment and 79 (86%) achieved SVR. While sociodemographic and behavioral factors including recent injection drug use were not significantly associated with achieving SVR, being fully adherent (p=0.042), number of doses taken (p=0.008) and treatment completion (p= 0.001) were associated with higher odds of achieving SVR. Conclusions DOT with PCM-support was an effective model for HCV treatment among PWID in this LMIC setting. Adherence was the most important driver of SVR suggesting DOT and PCM support can overcome other factors that might limit adherence. Further research is necessary to ascertain the effectiveness of other models of HCV care for PWID in LMICs given NSP and MAT access is variable, and DOT may not be sustainable with limited resources.

U2 - 10.1016/j.drugpo.2023.103959

DO - 10.1016/j.drugpo.2023.103959

M3 - Article (Academic Journal)

C2 - 36758335

SN - 0955-3959

VL - 113

SP - 1

EP - 8

JO - International Journal of Drug Policy

JF - International Journal of Drug Policy

M1 - 103959

ER -

Predictors of Hepatitis C Cure among People Who Inject Drugs Treated with Directly Observed Therapy supported by Peer Case Managers in Kenya

Abstract

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