Journal
OPEN FORUM INFECTIOUS DISEASES
Volume 8, Issue 8, Pages -Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/ofid/ofab334
Keywords
cascade; hepatitis C; HIV; patient navigation; substance use
Categories
Funding
- National Drug Abuse Treatment Clinical Trials Network [UG1DA013720, UG1DA015815, UG1DA013035, HHSN271201400028C, HHSN271201500065C, UG1DA013034, UG1DA015831, UG1DA020024, UG1DA013732, UG1DA013727]
- University of Miami [P30A1073961]
- Emory University Centers for AIDS Research [P30AI050409]
- New York University Center for Drug Use and HIV/HCV Research [P30DA011041]
- University of Miami Center for HIV and Research in Mental Health [P30MH116867]
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In this study, the care facilitation intervention led to greater progress along the HCV/HIV care continuum, especially for men. However, challenges remain in achieving individual-patient SVR and population-level HCV elimination.
Background. Direct-acting antivirals can cure hepatitis C virus (HCV). Persons with HCV/HIV and living with substance use are disadvantaged in benefiting from advances in HCV treatment. Methods. In this randomized controlled trial, participants with HCV/HIV were randomized between February 2016 and January 2017 to either care facilitation or control. Twelve-month follow-up assessments were completed in January 2018. Care facilitation group participants received motivation and strengths-based case management addressing retrieval of HCV viral load results, engagement in HCV/HIV care, and medication adherence. Control group participants received referral to HCV evaluation and an offer of assistance in making care appointments. Primary outcome was number of steps achieved along a series of 8 clinical steps (eg, receiving HCV results, initiating treatment, sustained virologic response [SVR]) of the HCV/HIV care continuum over 12 months postrandomization. Results. Three hundred eighty-one individuals were screened and 113 randomized. Median age was 51 years; 58.4% of participants were male and 72.6% were Black/African American. Median HIV-1 viral load was 27 209 copies/mL, with 69% having a detectable viral load. Mean number of steps completed was statistically significantly higher in the intervention group vs controls (2.44 vs 1.68 steps; chi(2) [1] = 7.36, P = .0067). Men in the intervention group completed a statistically significantly higher number of steps than controls. Eleven participants achieved SVR with no difference by treatment group. Conclusions. The care facilitation intervention increased progress along the HCV/HIV care continuum, as observed for men and not women. Study findings also highlight continued challenges to achieve individual-patient SVR and population-level HCV elimination.
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