Piloting Hepatitis C Virus Treatment in People Who Inject Drugs (PWID) in Bangladesh

Background: Treatment of hepatitis C virus infection in people who inject drugs (PWID) is complicated by their lifestyle, lack of social and family support, adherence to treatment, and reinfections. This study assessed the feasibility of treating HCV infection with direct-acting antiviral (DAA) among PWID who were receiving services from one Drop-in-Centre (DIC) in Dhaka, Bangladesh.   Methods: In this prospective study, 200 PWID were enrolled between May to July 2017. Blood was collected to conduct relevant laboratory tests. Face to face interviews were conducted to determine HCV related risk behaviours. All eligible PWID who were HCV RNA positive were provided daily daclatasvir (60 mg) and sofosbuvir (400 mg) for 12 weeks after which adherence level, SVR, and reinfections were assessed.   Findings: Antibodies to HCV were positive for 79 (39·5%) and HCV RNA for 68 (34%). The risk of HCV infection was significantly higher among those who had been injecting drugs for more than seven years (AOR: 2·1; 95% CI: 1·0-4·2; p=0·05). Of 55 eligible PWID started on treatment, 48 were available for SVR assessment (Intention-to-treat SVR 87%). All achieved SVR except one reinfection (4·2 cases per 100 person¬-years). 75% (41 of 55) were at least 90% adherent to therapy. The new infection rate was 2·04 cases per 100 person-years (49 person years of follow-up). Interpretation: Our findings confirm that HCV treatment using sofosbuvir+daclatasvir for PWID enrolled in existing harm reduction programme in Bangladesh is feasible but requires additional interventions such as Opioid Substitution Therapy, intense follow-up, and counselling by study staffs.   Funding Statement: World Health Organization. Declaration of Interests: All authors declare no competing interests. Ethics Approval Statement: International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) has approved this study (PR-16033) after receiving the approval from institutional Research Review Committee (RRC) and Ethical Review Committee (ERC). The participants provided the written consent prior to enrollment.