Overreporting of adherence to hepatitis C direct-acting antiviral therapy and sustained virologic response among people who inject drugs in the HERO study
Abstract Background Self-reported adherence to direct-acting antivirals (DAAs) to treat hepatitis C virus (HCV) among persons who inject drugs (PWID) is often an overreport of objectively measured adherence. The association of such overreporting with sustained virologic response (SVR) is understudie...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-02-01
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| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12879-024-09124-3 |
| _version_ | 1797275697679433728 |
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| author | Snehal S. Lopes Irene Pericot-Valverde Paula J. Lum Lynn E. Taylor Shruti H. Mehta Judith I. Tsui Judith Feinberg Arthur Y. Kim Brianna L. Norton Kimberly Page Cristina Murray-Krezan Jessica Anderson Alison Karasz Julia Arnsten Phillip Moschella Moonseong Heo Alain H. Litwin |
| author_facet | Snehal S. Lopes Irene Pericot-Valverde Paula J. Lum Lynn E. Taylor Shruti H. Mehta Judith I. Tsui Judith Feinberg Arthur Y. Kim Brianna L. Norton Kimberly Page Cristina Murray-Krezan Jessica Anderson Alison Karasz Julia Arnsten Phillip Moschella Moonseong Heo Alain H. Litwin |
| author_sort | Snehal S. Lopes |
| collection | DOAJ |
| description | Abstract Background Self-reported adherence to direct-acting antivirals (DAAs) to treat hepatitis C virus (HCV) among persons who inject drugs (PWID) is often an overreport of objectively measured adherence. The association of such overreporting with sustained virologic response (SVR) is understudied. This study among PWID aimed to determine a threshold of overreporting adherence that optimally predicts lower SVR rates, and to explore correlates of the optimal overreporting threshold. Methods This study analyzed per-protocol data of participants with adherence data (N = 493) from the HERO (Hepatitis C Real Options) study. Self-reported and objective adherence to a 12-week DAA regimen were measured using visual analogue scales and electronic blister packs, respectively. The difference (Δ) between self-reported and objectively measured adherence was calculated. We used the Youden index based on receiver operating characteristic (ROC) curve analysis to identify an optimal threshold of overreporting for predicting lower SVR rates. Factors associated with the optimal threshold of overreporting were identified by comparing baseline characteristics between participants at/above versus those below the threshold. Results The self-reported, objective, and Δ adherence averages were 95.1% (SD = 8.9), 75.9% (SD = 16.3), and 19.2% (SD = 15.2), respectively. The ≥ 25% overreporting threshold was determined to be optimal. The SVR rate was lower for ≥ 25% vs. < 25% overreporting (86.7% vs. 95.8%, p <.001). The factors associated with ≥ 25% Δ adherence were unemployment; higher number of days and times/day of injecting drugs; higher proportion of positive urine drug screening for amphetamine, methamphetamine, and oxycodone, and negative urine screening for THC (tetrahydrocannabinol)/cannabis. Conclusions Self-reported DAA adherence was significantly greater than objectively measured adherence among PWID by 19.2%. Having ≥ 25% overreported adherence was associated with optimal prediction of lower SVR rates. PWID with risk factors for high overreporting may need to be more intensively managed to promote actual adherence. |
| first_indexed | 2024-03-07T15:18:14Z |
| format | Article |
| id | doaj.art-9c336d8dbf30498a87f9f33fc5063a19 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-03-07T15:18:14Z |
| publishDate | 2024-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-9c336d8dbf30498a87f9f33fc5063a192024-03-05T17:49:44ZengBMCBMC Infectious Diseases1471-23342024-02-0124111110.1186/s12879-024-09124-3Overreporting of adherence to hepatitis C direct-acting antiviral therapy and sustained virologic response among people who inject drugs in the HERO studySnehal S. Lopes0Irene Pericot-Valverde1Paula J. Lum2Lynn E. Taylor3Shruti H. Mehta4Judith I. Tsui5Judith Feinberg6Arthur Y. Kim7Brianna L. Norton8Kimberly Page9Cristina Murray-Krezan10Jessica Anderson11Alison Karasz12Julia Arnsten13Phillip Moschella14Moonseong Heo15Alain H. Litwin16Department of Public Health Sciences, Clemson UniversityDepartment of Psychology, College of Behavioral, Social, and Health Sciences, Clemson UniversityDepartment of Medicine, University of California, San FranciscoDepartment of Pharmacy Practice and Clinical Research, University of Rhode IslandDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public HealthDepartment of Medicine, University of WashingtonDepartment of Behavioral Medicine and Psychiatry, West Virginia University School of MedicineDivision of Infectious Diseases, Massachusetts General HospitalAlbert Einstein College of MedicineDepartment of Internal Medicine, Health Sciences Center, University of New Mexico, University of New MexicoDivision of General Internal Medicine, Department of Medicine, University of Pittsburgh School of MedicineDepartment of Internal Medicine, Health Sciences Center, University of New Mexico, University of New MexicoUMass Chan Medical School, University of Massachusetts Medical SchoolAlbert Einstein College of MedicineDepartment of Emergency Medicine, Prisma HealthDepartment of Public Health Sciences, Clemson UniversitySchool of Health Research, Clemson UniversityAbstract Background Self-reported adherence to direct-acting antivirals (DAAs) to treat hepatitis C virus (HCV) among persons who inject drugs (PWID) is often an overreport of objectively measured adherence. The association of such overreporting with sustained virologic response (SVR) is understudied. This study among PWID aimed to determine a threshold of overreporting adherence that optimally predicts lower SVR rates, and to explore correlates of the optimal overreporting threshold. Methods This study analyzed per-protocol data of participants with adherence data (N = 493) from the HERO (Hepatitis C Real Options) study. Self-reported and objective adherence to a 12-week DAA regimen were measured using visual analogue scales and electronic blister packs, respectively. The difference (Δ) between self-reported and objectively measured adherence was calculated. We used the Youden index based on receiver operating characteristic (ROC) curve analysis to identify an optimal threshold of overreporting for predicting lower SVR rates. Factors associated with the optimal threshold of overreporting were identified by comparing baseline characteristics between participants at/above versus those below the threshold. Results The self-reported, objective, and Δ adherence averages were 95.1% (SD = 8.9), 75.9% (SD = 16.3), and 19.2% (SD = 15.2), respectively. The ≥ 25% overreporting threshold was determined to be optimal. The SVR rate was lower for ≥ 25% vs. < 25% overreporting (86.7% vs. 95.8%, p <.001). The factors associated with ≥ 25% Δ adherence were unemployment; higher number of days and times/day of injecting drugs; higher proportion of positive urine drug screening for amphetamine, methamphetamine, and oxycodone, and negative urine screening for THC (tetrahydrocannabinol)/cannabis. Conclusions Self-reported DAA adherence was significantly greater than objectively measured adherence among PWID by 19.2%. Having ≥ 25% overreported adherence was associated with optimal prediction of lower SVR rates. PWID with risk factors for high overreporting may need to be more intensively managed to promote actual adherence.https://doi.org/10.1186/s12879-024-09124-3AdherenceOverreportingSelf-reportObjective measureVisual analog scaleElectronic blister pack |
| spellingShingle | Snehal S. Lopes Irene Pericot-Valverde Paula J. Lum Lynn E. Taylor Shruti H. Mehta Judith I. Tsui Judith Feinberg Arthur Y. Kim Brianna L. Norton Kimberly Page Cristina Murray-Krezan Jessica Anderson Alison Karasz Julia Arnsten Phillip Moschella Moonseong Heo Alain H. Litwin Overreporting of adherence to hepatitis C direct-acting antiviral therapy and sustained virologic response among people who inject drugs in the HERO study BMC Infectious Diseases Adherence Overreporting Self-report Objective measure Visual analog scale Electronic blister pack |
| title | Overreporting of adherence to hepatitis C direct-acting antiviral therapy and sustained virologic response among people who inject drugs in the HERO study |
| title_full | Overreporting of adherence to hepatitis C direct-acting antiviral therapy and sustained virologic response among people who inject drugs in the HERO study |
| title_fullStr | Overreporting of adherence to hepatitis C direct-acting antiviral therapy and sustained virologic response among people who inject drugs in the HERO study |
| title_full_unstemmed | Overreporting of adherence to hepatitis C direct-acting antiviral therapy and sustained virologic response among people who inject drugs in the HERO study |
| title_short | Overreporting of adherence to hepatitis C direct-acting antiviral therapy and sustained virologic response among people who inject drugs in the HERO study |
| title_sort | overreporting of adherence to hepatitis c direct acting antiviral therapy and sustained virologic response among people who inject drugs in the hero study |
| topic | Adherence Overreporting Self-report Objective measure Visual analog scale Electronic blister pack |
| url | https://doi.org/10.1186/s12879-024-09124-3 |
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