Care Facilitation Advances Movement Along the Hepatitis C Care Continuum for Persons With Human Immunodeficiency Virus, Hepatitis C, and Substance Use: A Randomized Clinical Trial (CTN-0064)

• Type of Material: Article
• Authors: Lisa R Metsch, Columbia University; Daniel J Feaster, University of Miami; Lauren K Gooden, Columbia University; Carmen Masson, University of California San Francisco; David C Perlman, Icahn School of Medicine at Mount Sinai; Mamta K Jain, Univ Texas Southwestern Med Ctr Dallas; Tim Matheson, San Francisco Department of Public Health; Mindy C Nelson, University of Miami; Petra Jacobs, National Institute on Drug Abuse, Rockville; Susan Tross, Columbia University; Louise Haynes, Medical University of South Carolina; Gregory M Lucas, Johns Hopkins University; Jonathan Colasanti, Emory University; Allan Rodriguez, University of Miami; Mari-Lynn Drainoni, Boston University; Georgina Osorio, Icahn School of Medicine at Mount Sinai; Ank E Nijhawan, University of Texas Southwestern Medical Center and Parkland Health & Hospital System; Jeffrey M Jacobson, Case Western Reserve University; Meg Sullivan, Boston University; David Metzger, University of Pennsylvania; Pamela Vergara-Rodriguez, John H. Stroger, Jr Hospital of Cook County, Chicago; Ronald Lubelchek, John H. Stroger, Jr Hospital of Cook County, Chicago; Rui Duan, University of Miami; Jacob N Batycki, University of Miami; Abigail G Matthews, The Emmes Company, LLC, Rockville; Felipe Munoz, The Emmes Company, LLC, Rockville; Eve Jelstrom, The Emmes Company, LLC, Rockville; Raul Mandler, National Institute on Drug Abuse, Rockville; Carlos del Rio, Emory University
• Language: English
• Date: 2021-08-01
• Publisher: OXFORD UNIV PRESS INC
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2021. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1093/ofid/ofab334
• Title of Journal or Parent Work: OPEN FORUM INFECTIOUS DISEASES
• Volume: 8
• Issue: 8
• Start Page: ofab334
• End Page: ofab334
• Grant/Funding Information: This work was supported by the National Drug Abuse Treatment Clinical Trials Network (grant numbers UG1DA013720, UG1DA015815, UG1DA013035, HHSN271201400028C, HHSN271201500065C, UG1DA013034, UG1DA015831, UG1DA020024, UG1DA013732, and UG1DA013727); the University of Miami (grant number P30A1073961) and Emory University (grant number P30AI050409) Centers for AIDS Research; the New York University Center for Drug Use and HIV/HCV Research (grant number P30DA011041); and the University of Miami Center for HIV and Research in Mental Health (grant number P30MH116867).
• Keywords: Infectious Diseases; cascade; EFFICACY; INTERVENTION; ELIMINATION; HCV INCIDENCE; INJECT DRUGS; ANTIRETROVIRAL THERAPY; INITIATION; HIV; Microbiology; BARRIERS; patient navigation; hepatitis C; substance use; HIV-INFECTED PERSONS; Immunology; Science & Technology; EMERGENCY-DEPARTMENT; Life Sciences & Biomedicine
• Research Categories: Health Sciences, Mental Health; Health Sciences, Medicine and Surgery; Health Sciences, Public Health

Abstract

Background: Direct-acting antivirals can cure hepatitis C virus (HCV). Persons with HCV/HIV and living with substance use are disadvantaged in benefiting from advances in HCV treatment. Methods: In this randomized controlled trial, participants with HCV/HIV were randomized between February 2016 and January 2017 to either care facilitation or control. Twelve-month follow-up assessments were completed in January 2018. Care facilitation group participants received motivation and strengths-based case management addressing retrieval of HCV viral load results, engagement in HCV/HIV care, and medication adherence. Control group participants received referral to HCV evaluation and an offer of assistance in making care appointments. Primary outcome was number of steps achieved along a series of 8 clinical steps (eg, receiving HCV results, initiating treatment, sustained virologic response [SVR]) of the HCV/HIV care continuum over 12 months postrandomization. Results: Three hundred eighty-one individuals were screened and 113 randomized. Median age was 51 years; 58.4% of participants were male and 72.6% were Black/African American. Median HIV-1 viral load was 27 209 copies/mL, with 69% having a detectable viral load. Mean number of steps completed was statistically significantly higher in the intervention group vs controls (2.44 vs 1.68 steps; χ2 [1]=7.36, P.0067). Men in the intervention group completed a statistically significantly higher number of steps than controls. Eleven participants achieved SVR with no difference by treatment group. Conclusions: The care facilitation intervention increased progress along the HCV/HIV care continuum, as observed for men and not women. Study findings also highlight continued challenges to achieve individual-patient SVR and population-level HCV elimination. Clinical Trials Registration: NCT02641158.