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To date, studies examining HCV treatment outcomes among PWID using DAA therapy have been conducted predominantly in higher income settings. Individuals who had a detectable HCV viral load at post-treatment week 12 or those who were missing an HCV viral load at post-treatment week 12 were classified as a treatment failure. Keywords: Africa; DAA; HCV; LMIC; PWID EN Africa DAA HCV LMIC PWID 691 694 4 07/13/22 20220801 NES 220801 Abbreviations APRI Aspartate Aminotransferase to Platelet Ratio Index CTP Child-Turcotte-Pugh DAA Direct-acting antivirals DOT Directly observed therapy FIB-4 Fibrosis-4 HBV Hepatitis B virus HCV Hepatitis C virus KSH Kenyan shilling LDV Ledipasvir LMICs Low- and middle-income countries MAT Medication-assisted treatment NSP Needle and syringe programmes PCM Peer case manager PWID People who inject drugs SOF Sofosbuvir SSA Sub-Saharan Africa SVR Sustained virologic response INTRODUCTION Although between 10 and 15 million of the estimated 71 million people worldwide living with the hepatitis C virus (HCV) live in sub-Saharan Africa (SSA),1 recent data suggest only 1% of these individuals have accessed HCV treatment.1 Diminished access has been attributed to the financial and geographical barriers to general medical care, and limited regional availability of direct-acting antivirals (DAA). [Extracted from the article]

• Harm reduction settings allow access to care for people who inject drugs (PWID). • We studied co-located HCV therapy for PWID in harm reduction settings in Kenya. • Directly observed therapy (DOT) with peer support was feasible and effective. • Adherence was the most important driver of HCV cure. • DOT and peer support can overcome other factors that might limit adherence. Directly observed therapy (DOT) maximizes adherence and minimizes treatment gaps. Peer case managers (PCM) have also shown promise as a component of integrated HCV treatment strategies. DOT and PCM-support have been underexplored, particularly in low- and middle-income countries (LMICs). The objective of this study was to evaluate predictors of sustained virologic response (SVR) among people who inject drugs (PWID) attending medication-assisted treatment (MAT) and needle and syringe programs (NSP) sites in Kenya. We recruited PWID accessing MAT and NSP in Nairobi and Coastal Kenya. PWID were treated with ledipasvir/sofosbuvir using DOT supported by PCMs. We used bivariate and multivariate logistic regression to examine the impact of sociodemographic, behavioral, and clinical factors on SVR. Among 92 PWID who initiated HCV treatment, 79 (86%) were male with mean age of 36.3 years (SD=±6.5); 38 (41%) were HIV-positive, and 87 (95%) reported injecting drugs in the last 30 days. Just over half of participants were genotype 1a (55%), followed by genotype 4a (41%) and mixed 1a/4a (3%). Most participants, 85 (92%) completed treatment and 79 (86%) achieved SVR. While sociodemographic and behavioral factors including recent injection drug use were not significantly associated with achieving SVR, being fully adherent (p=0.042), number of doses taken (p=0.008) and treatment completion (p= 0.001) were associated with higher odds of achieving SVR. DOT with PCM-support was an effective model for HCV treatment among PWID in this LMIC setting. Adherence was the most important driver of SVR suggesting DOT and PCM support can overcome other factors that might limit adherence. Further research is necessary to ascertain the effectiveness of other models of HCV care for PWID in LMICs given NSP and MAT access is variable, and DOT may not be sustainable with limited resources. [ABSTRACT FROM AUTHOR]

Objectives: People who inject drugs (PWID) in Kenya have high HIV (range across settings: 14-26%) and hepatitis C virus (HCV; 11-36%) prevalence. We evaluated the impact of existing and scaled-up interventions on HIV and HCV incidence among PWID in Kenya., Design: HIV and HCV transmission model among PWID, calibrated to Nairobi and Kenya's Coastal region., Methods: For each setting, we projected the impact (percent of HIV/HCV infections averted in 2020) of existing coverages of antiretroviral therapy (ART; 63-79%), opioid agonist therapy (OAT; 8-13%) and needle and syringe programmes (NSP; 45-61%). We then projected the impact (reduction in HIV/HCV incidence over 2021-2030), of scaling-up harm reduction [Full harm reduction ('Full HR'): 50% OAT, 75% NSP] and/or HIV (UNAIDS 90-90-90) and HCV treatment (1000 PWID over 2021-2025) and reducing sexual risk (by 25/50/75%). We estimated HCV treatment levels needed to reduce HCV incidence by 90% by 2030., Results: In 2020, OAT and NSP averted 46.0-50.8% (range of medians) of HIV infections and 50.0-66.1% of HCV infections, mostly because of NSP. ART only averted 12.9-39.8% of HIV infections because of suboptimal viral suppression (28-48%). Full HR and ART could reduce HIV incidence by 51.5-64% and HCV incidence by 84.6-86.6% by 2030. Also halving sexual risk could reduce HIV incidence by 68.0-74.1%. Alongside full HR, treating 2244 PWID over 2021-2025 could reduce HCV incidence by 90% by 2030., Conclusion: Existing interventions are having substantial impact on HIV and HCV transmission in Kenya. However, to eliminate HIV and HCV, further scale-up is needed with reductions in sexual risk and HCV treatment., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.)