title: High prevalence of willingness to use direct-acting antiviral-based regimens for hepatitis C virus (HCV) infection among HIV/HCV coinfected people who use drugs.
abstract: Despite the high burden of hepatitis C virus (HCV)-related morbidity and mortality among HIV-positive people who use illicit drugs (PWUD), uptake of interferon-based treatments for HCV infection has been negligible among this group. Direct-acting antiviral (DAA) therapies offer an opportunity to expand treatment access among this population. The aim of this study was to explore willingness to use DAA-based regimens among HIV/HCV-coinfected PWUD in Vancouver, Canada.
  
  
  
  Data were drawn from the AIDS Care Cohort to evaluate Exposure to Survival Services (ACCESS), a prospective cohort of HIV-positive PWUD. Using logistic regression analyses, we investigated factors associated with willingness to use DAA-based regimens among HIV/HCV-coinfected participants.
  
  
  
  Of 418 HIV/HCV-coinfected PWUD surveyed between June 2014 and May 2015, 295 (71%) were willing to use DAA-based regimens. In multivariable analysis, participants enrolled in methadone maintenance therapy [adjusted odds ratio (AOR) 1.61; 95% confidence interval (CI) 1.04-2.51], those with a recent assessment by an HCV specialist (AOR 2.02; 95% CI 1.28-3.19) and those who perceived that HCV infection was affecting their health (AOR 2.49; 95% CI 1.41-4.37) were more likely to be willing to use DAA-based regimens.
  
  
  
  Overall, this study found a high prevalence of willingness to use DAA-based regimens among HIV/HCV-coinfected PWUD in Vancouver. Importantly, enrolment in methadone maintenance therapy was positively associated with willingness, suggesting that integrated models of HIV, HCV and addiction care should be explored as a way to address HCV-related morbidity and mortality among HIV/HCV-coinfected PWUD.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.|Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada.
authors.forename: M E
authors.initials: ME
authors.lastname: Socías
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.|Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Ti
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.
authors.forename: H
authors.initials: H
authors.lastname: Dong
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.|School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Shoveller
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.|Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada.
authors.forename: T
authors.initials: T
authors.lastname: Kerr
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.|Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Montaner
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.|Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada.
authors.forename: M-J
authors.initials: MJ
authors.lastname: Milloy
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D002170:Canada / Q000453:epidemiology; D060085:Coinfection / Q000188:drug therapy*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D006526:Hepatitis C / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D010349:Patient Compliance / Q000706:statistics & numerical data; D015995:Prevalence; D011446:Prospective Studies; D019966:Substance-Related Disorders / Q000150:complications*; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents
keywords: 
  HIV
  ; direct-acting antiviral agents; hepatitis C; methadone maintenance therapy; people who use drugs