Treatment Adherence Among People Who Inject Drugs Taking Directly Observed Direct Acting Antiviral Therapy At Kirketon Road Centre

Author: Chronister KJ, Gilliver R, Kearley J, Lothian R, Dore GJ, Read P

Theme: Clinical Research Year: 2017

Background: The Kirketon Road Centre (KRC) is a primary health care service in Kings Cross, Sydney, providing prevention, treatment and care of viral hepatitis for people who inject drugs (PWID). KRC developed an individualised adherence support program for direct-acting antiviral (DAA) therapy, with those assessed as requiring maximum support receiving daily directly observed treatment (DOT). With daily DOT, missed doses led to extended treatment until the planned total doses were administered. Our aim is to report adherence of clients undergoing daily DOT and the proportion who extended duration of treatment.

Methods: Daily dosing of DAAs was recorded on medical prescription charts. Data were analysed to determine the number of missed doses, extended duration of treatment, and median adherence with and without extension.

Results: Twenty-six of 120 (22%) clients initiated on DAA therapy from March 2016 elected to receive DAAs as DOT. The mean age of these clients was 40 years, 16 (62%) were male, 13 (50%) identified as Aboriginal or Torres Strait Islander, 22 (84%) were prescribed OST, 23 (89%) injected drugs in the last 6 months, 12 (46%) sex worked in the last 12 month, 94% had been in custody, all were unemployed, and 62% were homeless. Median adherence for four-weekly dosing periods ranged from 89-93%. Seventeen (65%) clients required extension of treatment (median 5 days, range 2-41), including 6 clients who extended by at least two weeks. At expected end of treatment the median proportion of doses missed was 7% (IQR 5-15%) which was reduced to 1% (range 0-5%) by extending treatment. Among those who are 12 weeks post-treatment with HCV RNA assessment (n=20) all are undetectable.

Conclusion: This study demonstrates daily dosing can achieve high medication adherence for socially marginalised clients within this model of care. Further, extension of treatment to adjust for missed doses appears feasible.

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