People who inject drugs adhere better to their hepatitis C virus (HCV) therapy if they receive directly observed treatment compared with being given direct--acting antiviral medication to take on their own. 

Researchers conducted a randomized controlled trial at three medication-assisted treatment programs for those with opioid use disorder in New York City. One hundred fifty participants were randomized into three study arms and received directly observed hep C therapy, treatment as a group or treatment to take on their own.

About two out of three of the participants had used drugs during the previous six months, and almost half used opioids or cocaine. Three quarters of the study members reported a history of injection drug use.

Those in the directly observed therapy group took an average of 86% of their HCV medication doses, compared with 75% of those in the self-administered individual treatment group. This difference was statistically significant, meaning it is unlikely to have been driven by chance. Those in the group-treatment arm had an average adherence rate of 80%, which was not significantly different from that of the self-administered treatment group.

Overall, 94% of the study members were cured of HCV. There was no difference in the cure rate based on the study group or other participant characteristics.

Noting that research has not clarified the optimal level of adherence to hep C treatment that best predicts whether someone will be cured, the study authors called for a larger study that might definitively conclude whether these three ways of delivering therapy for the virus are truly the same in terms of cure outcomes.

“Our study supports the treatment of HCV in people who are currently injecting drugs,” says the study’s lead author, Alain H. Litwin, MD, MPH, an internist at Prisma Health in Greenville, South Carolina. “In order to move toward the World Health Organization HCV elimination goals, we should urgently treat HCV in people who inject drugs.”