Directly observed treatment for hepatitis C achieved a very
high cure rate in people who inject drugs, an Austrian study carried out in
pharmacies and drugs projects offering opioid substitution therapy has
The study findings, published in the journal PLOS ONE,
showed that daily directly observed treatment with the fixed-dose direct-acting
antiviral regimen glecaprevir/pibrentasvir cured 94% of people.
People who inject drugs and who are attending outpatient
opioid substitution therapy facilities such as a community pharmacy are often
reluctant to attend hospital clinics after diagnosis with hepatitis C. Testing
for hepatitis C in pharmacies that are providing opioid substitution therapy
has revealed that a high proportion of people diagnosed with hepatitis C in
this setting have received a previous hepatitis C diagnosis, for example.
Delivering hepatitis C treatment through community
pharmacies could enable more people who inject drugs to be cured of the
infection. A pilot testing project in community pharmacies in London revealed a
strong preference for delivery of hepatitis C treatment through community
In Vienna around 6500 people who inject drugs receive
opioid substitution therapy through a community pharmacy or low threshold drugs
project. Approximately one in three have hepatitis C.
Researchers at the Wilheminenspital and the Medical
University of Vienna investigated the effectiveness of directly observed
treatment or standard hospital treatment in 145 people who inject drugs.
People who inject drugs were assessed by addiction medicine
specialists, a nurse and a hepatologist to determine their likelihood of
adhering to self-administered treatment dispensed by the clinic. Those thought
likely to experience difficulties were assigned to directly observed treatment
in a community setting (n = 74). Those thought able to adhere to treatment
dispensed once a month and taken at home were assigned to hospital care (n = 71).
People assigned to directly observed treatment received
medication at a pharmacy or walk-in drug clinic from Monday to Saturday at the
same time as opioid substitution therapy and were given a dose of medication to
take on Sunday when the facilities were closed.
There were no significant differences between the two
treatment groups except for age; those who received clinic treatment were older
(50 years vs 38 years, p < 0.0001). Sixty-two per cent of study participants
were male, almost all (93%) had no previous experience of treatment and 85% had
early-stage liver disease (F0/F1/F2).
Those in the directly observed treatment group were more likely to be unemployed
(86% vs 69%), less likely to have their own housing (52% vs 17%) and more
likely to have been in prison (66% vs 1%).
Treatment was highly effective in the directly observed treatment group; 70 out of
74 achieved a sustained virologic response (94.6%), two patients were lost to
follow-up, one died after treatment and before SVR measurement and one patient
with genotype 3 infection did not respond to treatment.
In the clinic treatment group, 69 out of 71 achieved a
sustained virologic response (97.2%); one patient was lost to follow-up and one
patient with genotype 3 infection experienced viral rebound 12 weeks after
completion of treatment.
Adherence was high in the directly observed treatment group; 70 out of 74 did not
miss a single dose. Among those who missed doses, three out of four achieved a
sustained virologic response, and overall, only 32 out of 3332 scheduled doses
were missed in the directly observed treatment study group.
No serious adverse events were reported in either study
The study investigators say that directly observed treatment "may represent a key measure in order to contribute to the hepatitis C virus elimination target" in people who inject drugs who are accessing opioid substitution therapy. The study also underlines the importance of making opioid substitution therapy available through community pharmacies and the potential value of these services as access points for hepatitis C treatment.