{"doi":"10.1111/jvh.13756","title":"More intensive hepatitis C virus care models promote adherence among people who inject drugs with active drug use: The <scp>PREVAIL</scp> study","abstract":"Direct-acting antiviral (DAA) therapies are more effective for treating hepatitis C virus (HCV) with higher rates of sustained virologic response (SVR) and fewer side effects than older interferon-based treatments.1 DAAs are effective even among people who inject drugs (PWID),2 a population disproportionately infected by HCV.3 Nonetheless, adequate adherence is crucial for PWID living with HCV to achieve SVR and reduce transmission, a public health goal which has been prioritized for global efforts to eliminate HCV by 2030.4 How ongoing drug use interferes with HCV treatment adherence support remains unknown.5, 6 The PREVAIL study2 was conducted in opioid treatment program (OTP) settings to test the effectiveness of three models of HCV care for PWID. The trial showed that higher adherence was associated with successful SVR and the adherence level was highest among participants treated with modified directly observed therapy (mDOT) compared to those treated with groups therapy (GT) or standard individual therapy (SIT).7 We examined whether more intensive care models such as mDOT or GT would also increase adherence even among participants with active drug use compared to those without at baseline and during treatment. We performed a secondary analysis of data from the PREVAIL study that randomized three HCV care models—SIT, GT and mDOT—with a 1:1:1 randomized allocation ratio. The study was conducted at three OTP clinics that offer on-site medical care in the Bronx, NY. Electronic blister packs were used to record the time and date of each opening for a medication retrieval.8 Treatment regimens included combination DAA treatments of sofosbuvir/ledipasvir or sofosbuvir/simeprevir, and interferon-containing treatments of telaprevir/pegylated interferon/ribavirin, sofosbuvir/pegylated interferon/ribavirin or sofosbuvir/ribavirin. A total of N = 150 PWID were enrolled. We analysed data from N = 147 participants who returned at least one blister pack. Baseline characteristics stratified by treatment regimens are provided in Table S1. Urine toxicology tests were conducted at baseline and at Weeks 4, 8 and 12 research visits during the treatment period. Active drug use was defined by a urine toxicology being positive for amphetamine, benzodiazepine, cocaine, opiate or oxycodone. The distribution of use of each drug during the research visits is provided in Table S2. We considered four binary (yes vs. no) drug use indicator measures with respect to whether or not participants: (1) used any drug at baseline; (2) ever used any drug during treatment with one or more visits with a positive result; (3) frequently used any drug during treatment with two or more visits with a positive result; and (4) concurrently used any drug in a time-by-time fashion over the three visits during treatment. The first three measures are cross-sectional whereas the last is longitudinal. Adherence for every treatment day was determined based on the blister pack opening date, and daily time frame (DTF) window was set between 12:00 am to 11:59 pm. DTF adherence was defined as DTF = 0 for no opening, and DTF = 1 for one or more openings on a given treatment day. Undetermined DTF adherence on missing dates due to lost or unreturned blister pack (<4%) were treated as missing. DTF was converted to three monthly percentages of adherence to align with the urine toxicology test time frame. Although the prescribed treatment weeks varied (8, 12 or 24 weeks), the medications were dispensed in the electronic blister packs only up to 12 weeks. Baseline potential confounding clinical factors included cirrhosis status, IL28B genotypes, HIV co-infection, psychiatric illness (any major depressive episode, psychotic disorder, generalized anxiety disorder or current manic episode by medical chart review) and alcohol intoxication for one or more days within 30 days prior to baseline. Mixed-effects linear models were applied to compare adjusted adherence levels between participants w","journal":"Journal of Viral Hepatitis","year":2022,"id":289018,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":6,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9528,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":970209,"name":"Irene Pericot‐Valverde","orcid":"0000-0001-5814-0397","position":1,"is_corresponding":false},{"id":970695,"name":"Jiajing Niu","orcid":null,"position":2,"is_corresponding":false},{"id":607692,"name":"Brianna L. Norton","orcid":"0000-0002-8287-2245","position":3,"is_corresponding":false},{"id":337727,"name":"Matthew J. Akiyama","orcid":"0000-0003-4290-3083","position":4,"is_corresponding":false},{"id":367628,"name":"Shadi Nahvi","orcid":"0000-0001-5501-4942","position":5,"is_corresponding":false},{"id":315646,"name":"Julia H. Arnsten","orcid":"0000-0002-7741-1567","position":6,"is_corresponding":false},{"id":364242,"name":"Alain H. Litwin","orcid":"0000-0002-6717-0288","position":7,"is_corresponding":false},{"id":106483,"name":"Moonseong Heo","orcid":"0000-0001-7711-1209","position":0,"is_corresponding":true}],"reference_count":9,"raw_metadata":null,"created_at":"2026-07-19T00:30:18.766838Z","pmid":"36197920","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}