People who inject drugs and are coinfected with hepatitis C and HIV more often initiated treatment with innovative strategies, such as peer mentoring or cash incentives, compared with those who received standard care only, according to data presented at the International Symposium on Hepatitis Care in Substance Users.
Kathleen Ward, senior research program coordinator of the Johns Hopkins Medical Institutions, Baltimore, presented findings from the CHAMPS study, in which researchers enrolled 144 HIV/HCV coinfected people who inject drugs. All patients had genotype 1 and were treatment-naive, and no patient had hepatocellular carcinoma or decompensation.
Thirty-six patients received usual care, which consisted of an HIV clinic-based nursing model with pharmacy support. Fifty-four patients received usual care and peer-mentor care, in which the patients had contact with HIV-infected persons who achieved sustained virologic response for HCV and received training as peer mentors. An additional 54 patients received usual care and an offer of cash incentives contingent on attendance with a maximum possible compensation of $220.
The primary endpoint was HCV treatment initiation within 8 weeks of study enrollment. At 8 weeks, 67% of the patients from the usual care group initiated HCV treatment. Comparatively, 83% of the peer mentor group (relative risk = 2; 95% CI, 0.94-4.17) and 76% of the cash incentive group (RR = 1.39; 95% CI, 0.71-2.7) initiated treatment.
Of the 110 patients who initiated treatment, 12 did not reach 12 weeks of treatment to date, 88 achieved SVR (90% who reached 12 weeks of treatment), and 10 did not achieve SVR due to reinfection (n = 1), relapse (n = 2), stopping treatment (n = 6) or mortality (n = 1).
The researchers concluded by advocating for peer mentorship, cash incentives or other novel interventions to effectively improve the HCV care cascade and for the need of further studies to confirm and evaluate their efficacy. – by Talitha Bennett
Reference: Ward K. Randomized controlled trial of cash incentives or peer mentors to improve HCV linkage to treatment among HIV/HCV coinfected persons who inject drugs: the CHAMPS study. Presented at: International Symposium on Hepatitis Care in Substance Users; Sept. 6-8, 2017; New York.
Disclosure: Ward reports no relevant financial disclosures.