Author information

¹Department of Public Health Sciences, Clemson University, 29634, Clemson, SC, USA.

²Department of Psychology, College of Behavioral, Social, and Health Sciences, Clemson University, 29634, Clemson, SC, USA.

³Department of Medicine, University of California, San Francisco, 1001 Potrero Ave, 94110, San Francisco, CA, USA.

⁴Department of Pharmacy Practice and Clinical Research, University of Rhode Island, 7 Greenhouse Road, 02881, Kingston, RI, USA.

⁵Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E6546, 21205, Baltimore, MD, USA.

⁶Department of Medicine, University of Washington, 325 9th Ave, 98104, Seattle, WA, USA.

⁷Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, 930 Chestnut Ridge Road, 26505, Morgantown, WV, USA.

⁸Department of Medicine, Section of Infectious Diseases, West Virginia University School of Medicine, 1 Medical Center Drive, 26506, Morgantown, WV, USA.

⁹Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit St, 02114, Boston, MA, USA.

¹⁰Harvard Medical School, 02115, Boston, MA, USA.

¹¹Albert Einstein College of Medicine, 10461, Bronx, NY, USA.

¹²Department of Medicine, Montefiore Medical Center, 10467, Bronx, NY, USA.

¹³Department of Internal Medicine, Health Sciences Center, University of New Mexico, University of New Mexico, MSC 10, 5550, 87131, Albuquerque, NM, USA.

¹⁴Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, 15213, Pittsburgh, PA, USA.

¹⁵UMass Chan Medical School, University of Massachusetts Medical School, 55 Lake Ave, North, 01605, Worcester, MA, USA.

¹⁶Department of Emergency Medicine, Prisma Health, Greenville, SC, USA.

¹⁷School of Health Research, Clemson University, Clemson, SC, USA.

¹⁸Department of Medicine, University of South Carolina School of Medicine, 876 W Faris Rd, 29605, Greenville, SC, USA.

¹⁹School of Health Research, Clemson University, Clemson, SC, USA. alain.litwin@prismahealth.org.

²⁰Department of Medicine, University of South Carolina School of Medicine, 876 W Faris Rd, 29605, Greenville, SC, USA. alain.litwin@prismahealth.org.

²¹Department of Medicine, Prisma Health, 29605, Greenville, SC, USA. alain.litwin@prismahealth.org.

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.