Knowledge Around Direct Acting Antiviral Therapies And Willingness To Undergo HCV Treatment Among Rural Appalachian Opioid Users

Author: Havens JR, Rosenau J, Young AM, Lofwall MR, and Walsh SL

Theme: Epidemiology & Public Health Research Year: 2018

The opioid epidemic in Appalachia has also fueled the spread of the hepatitis C virus (HCV).
Direct acting antivirals (DAAs) offer a revolution in the treatment of HCV; however, access is
lacking in rural areas. The purpose of this study is to examine knowledge about DAAs and
willingness to initiate DAA treatment among HCV-positive people who use drugs (PWUD) in
Appalachian Kentucky.
This ongoing substudy of HCV antibody-positive individuals is nested within a cohort of 503
rural PWUD followed since 2008. To date, 56 participants have completed the interview, with
200 completed by August.
The majority of participants (83.9%) were aware of DAAs, but were unsure about how these
medications work. Less than a quarter (23.2%) understood that the duration of treatment
was 12 weeks or less, and 33.9% of participants believed that cure rates were lower than
90%. Two-thirds of those surveyed incorrectly stated that DAAs provided immunity against
re-infection. Overwhelmingly, participants indicated that they would be willing to initiate
treatment with DAAs, especially if the treatment was offered at low or no cost (94.6%). More
than half said that one pill per day for 12 weeks was preferable to three pills per day for 8
weeks. Local access to treatment was also important; 94.6% of participants indicated they
would be willing to take the medication if it were offered locally.
This cohort of PWUD had knowledge about the existence of DAAs, but specific knowledge
about the drug regimen, efficacy, and risks of re-infection after treatment was lacking. It is
encouraging that most participants were willing to take DAAs, although the price of the drug
and insurance restrictions would likely discourage access in this high risk population.
Research aimed at reducing the barriers to treatment are clearly needed in rural areas facing
the opioid/HCV syndemic.
Disclosure of Interest Statement: This research was funded by grants from the National
Institutes of Health (NIH R01 DA033862, DA024598 and R03 DA 043379) to Dr. Havens.

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