Outcomes of real-world integrated HCV microelimination for people who inject drugs: an expansion of the punjab model

Authors

Radha K. Dhiman, Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India; Hepatitis C Virus Infection, Punjab, India; Mukh-Mantri Punjab Hepatitis C Relief Fund (MMPHCRF), Punjab Government, Punjab, India; Technical Resource Group - National Viral Hepatitis Control Program (NVHCP), Government of India, India; Injection Safety Project, Punjab Government, Punjab, India
Gagandeep S. Grover, Hepatitis C Virus Infection, Punjab, India
Madhumita Prekumar, Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
Akash Roy, Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
Sunil Taneja, Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
Ajay Duseja, Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
Sanjeev Arora, ECHO Institute University of New Mexico, USA, New Mexico, United States
MMPHCRF Investigators

Document Type

Article

Publication Date

11-2021

Abstract

Background

The prevalence of chronic hepatitis C (CHC) in People Who Inject Drugs (PWID) is 8-10% as compared to 3·6% in the general population in Punjab, India. We assessed the real-world efficacy and safety of free-of-charge generic direct-acting antivirals (DAAs), sofosbuvir with an NS5A inhibitor (ledipasvir, daclatasvir or velpatasvir)±ribavirin in the microelimination of CHC in PWID in a public health setting.

Methods

An integrated care team at 25 sites provided algorithm based DAAs treatment to PWID supervised by telemedicine clinics between 18th June 2016 and 31st July 2019. The primary endpoint was sustained virological response at 12 weeks (SVR-12); the secondary endpoints were treatment completion, adherence, safety, and adverse events. ClinicalTrials.gov number: NCT01110447.

Findings

We enrolled 3477 PWID (87·2% men; mean age 33·6±12·5 years; 83·8% rural; 6·8% compensated cirrhosis). While 2280 (65·5%) patients completed treatment, 1978 patients completed 12 weeks of follow up for SVR-12. SVR-12 was achieved in 91·1% of patients per protocol, 49.5% as per intention to treat (ITT) and 90·1% in a modified ITT analysis. Of 546 (15·7%) patients with treatment interruptions, 99 (19·7%) could be traced to test for SVR-12 with a cure rate of 77·8%. There were no major adverse events or consequent treatment discontinuation.

Interpretation

Integrated care of PWID with CHC with DAAs is safe and effective. Measures for reducing treatment interruptions will further improve outcomes.

Funding

The Government of the state of Punjab, India under the Mukh Mantri Punjab Hepatitis C Relief Fund (MMPHCRF) project, funds the project.

Recommended Citation

Dhiman RK, Grover GS, Premkumar M, et al. Outcomes of real-world integrated hcv microelimination for people who inject drugs: an expansion of the punjab model. Eclinicalmedicine. 2021;41:101148-101148. doi:10.1016/j.eclinm.2021.101148