Evaluation of contingency management as a strategy to improve HCV linkage to care and treatment in persons attending needle and syringe programs: A pilot study

B. L. Norton, Marcus A. Bachhuber, R. Singh, L. Agyemang, J. H. Arnsten, C. O. Cunningham, A. H. Litwin

Research output: Contribution to journalArticle

Abstract

Background: A greater proportion of HCV-infected people who inject drugs (PWID) need to be linked to care for HCV antiviral treatment. This study sets out to evaluate the efficacy of contingency management (CM) for improving HCV linkage to care, treatment initiation, adherence, and cure for PWID recruited from a needle and syringe program. Methods: Between March 2015 and April 2016, 20 participants were enrolled into the CM arm, and then subsequently enrolled 20 participants in the enhanced standard of care (eSOC) arm. Participants in the eSOC arm received an expedited appointment and a round-trip transit card. Participants enrolled in the CM arm received eSOC plus $25 for up to ten HCV clinical visits and $10 for each returned weekly medication blister pack. Adherence was measured via electronic blister packs. Results: Overall the median age was 47 years; most were men (67%) and Hispanic (69%). There were no significant differences in demographic characteristics between participants in the study arms. In the CM arm 74% were linked to HCV care, compared to 30% in the eSOC arm (p = 0.01). In the CM arm, 75% (9/12) of treatment eligible participants initiated treatment, compared to 100%(4/4) in the eSOC arm (p = 0.53). All patients (9/9) achieved cure in the CM arm, as compared to 75% (3/4) of patients in the eSOC arm. There were no differences in adherence between study arms. Conclusions: In this pilot study, contingency management led to higher rates of HCV linkage to care for PWID, as compared to standard of care. CM should be considered as a possible intervention to improve the HCV treatment cascade for PWID.

Original languageEnglish (US)
Pages (from-to)1-7
Number of pages7
JournalInternational Journal of Drug Policy
Volume69
DOIs
StatePublished - Jul 1 2019

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Syringes
Standard of Care
Needles
Blister
Pharmaceutical Preparations
Therapeutics
Hispanic Americans
Antiviral Agents
Appointments and Schedules
Demography

Keywords

  • Contingency management
  • HCV
  • Linkage to care
  • Persons who inject drugs (PWID)
  • Syringe exchange programs

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Health Policy

Cite this

@article{07184b1fff464ad682a7782599ac3261,
title = "Evaluation of contingency management as a strategy to improve HCV linkage to care and treatment in persons attending needle and syringe programs: A pilot study",
abstract = "Background: A greater proportion of HCV-infected people who inject drugs (PWID) need to be linked to care for HCV antiviral treatment. This study sets out to evaluate the efficacy of contingency management (CM) for improving HCV linkage to care, treatment initiation, adherence, and cure for PWID recruited from a needle and syringe program. Methods: Between March 2015 and April 2016, 20 participants were enrolled into the CM arm, and then subsequently enrolled 20 participants in the enhanced standard of care (eSOC) arm. Participants in the eSOC arm received an expedited appointment and a round-trip transit card. Participants enrolled in the CM arm received eSOC plus $25 for up to ten HCV clinical visits and $10 for each returned weekly medication blister pack. Adherence was measured via electronic blister packs. Results: Overall the median age was 47 years; most were men (67{\%}) and Hispanic (69{\%}). There were no significant differences in demographic characteristics between participants in the study arms. In the CM arm 74{\%} were linked to HCV care, compared to 30{\%} in the eSOC arm (p = 0.01). In the CM arm, 75{\%} (9/12) of treatment eligible participants initiated treatment, compared to 100{\%}(4/4) in the eSOC arm (p = 0.53). All patients (9/9) achieved cure in the CM arm, as compared to 75{\%} (3/4) of patients in the eSOC arm. There were no differences in adherence between study arms. Conclusions: In this pilot study, contingency management led to higher rates of HCV linkage to care for PWID, as compared to standard of care. CM should be considered as a possible intervention to improve the HCV treatment cascade for PWID.",
keywords = "Contingency management, HCV, Linkage to care, Persons who inject drugs (PWID), Syringe exchange programs",
author = "Norton, {B. L.} and Bachhuber, {Marcus A.} and R. Singh and L. Agyemang and Arnsten, {J. H.} and Cunningham, {C. O.} and Litwin, {A. H.}",
year = "2019",
month = "7",
day = "1",
doi = "10.1016/j.drugpo.2019.02.009",
language = "English (US)",
volume = "69",
pages = "1--7",
journal = "International Journal of Drug Policy",
issn = "0955-3959",
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TY - JOUR

T1 - Evaluation of contingency management as a strategy to improve HCV linkage to care and treatment in persons attending needle and syringe programs

T2 - A pilot study

AU - Norton, B. L.

AU - Bachhuber, Marcus A.

AU - Singh, R.

AU - Agyemang, L.

AU - Arnsten, J. H.

AU - Cunningham, C. O.

AU - Litwin, A. H.

PY - 2019/7/1

Y1 - 2019/7/1

N2 - Background: A greater proportion of HCV-infected people who inject drugs (PWID) need to be linked to care for HCV antiviral treatment. This study sets out to evaluate the efficacy of contingency management (CM) for improving HCV linkage to care, treatment initiation, adherence, and cure for PWID recruited from a needle and syringe program. Methods: Between March 2015 and April 2016, 20 participants were enrolled into the CM arm, and then subsequently enrolled 20 participants in the enhanced standard of care (eSOC) arm. Participants in the eSOC arm received an expedited appointment and a round-trip transit card. Participants enrolled in the CM arm received eSOC plus $25 for up to ten HCV clinical visits and $10 for each returned weekly medication blister pack. Adherence was measured via electronic blister packs. Results: Overall the median age was 47 years; most were men (67%) and Hispanic (69%). There were no significant differences in demographic characteristics between participants in the study arms. In the CM arm 74% were linked to HCV care, compared to 30% in the eSOC arm (p = 0.01). In the CM arm, 75% (9/12) of treatment eligible participants initiated treatment, compared to 100%(4/4) in the eSOC arm (p = 0.53). All patients (9/9) achieved cure in the CM arm, as compared to 75% (3/4) of patients in the eSOC arm. There were no differences in adherence between study arms. Conclusions: In this pilot study, contingency management led to higher rates of HCV linkage to care for PWID, as compared to standard of care. CM should be considered as a possible intervention to improve the HCV treatment cascade for PWID.

AB - Background: A greater proportion of HCV-infected people who inject drugs (PWID) need to be linked to care for HCV antiviral treatment. This study sets out to evaluate the efficacy of contingency management (CM) for improving HCV linkage to care, treatment initiation, adherence, and cure for PWID recruited from a needle and syringe program. Methods: Between March 2015 and April 2016, 20 participants were enrolled into the CM arm, and then subsequently enrolled 20 participants in the enhanced standard of care (eSOC) arm. Participants in the eSOC arm received an expedited appointment and a round-trip transit card. Participants enrolled in the CM arm received eSOC plus $25 for up to ten HCV clinical visits and $10 for each returned weekly medication blister pack. Adherence was measured via electronic blister packs. Results: Overall the median age was 47 years; most were men (67%) and Hispanic (69%). There were no significant differences in demographic characteristics between participants in the study arms. In the CM arm 74% were linked to HCV care, compared to 30% in the eSOC arm (p = 0.01). In the CM arm, 75% (9/12) of treatment eligible participants initiated treatment, compared to 100%(4/4) in the eSOC arm (p = 0.53). All patients (9/9) achieved cure in the CM arm, as compared to 75% (3/4) of patients in the eSOC arm. There were no differences in adherence between study arms. Conclusions: In this pilot study, contingency management led to higher rates of HCV linkage to care for PWID, as compared to standard of care. CM should be considered as a possible intervention to improve the HCV treatment cascade for PWID.

KW - Contingency management

KW - HCV

KW - Linkage to care

KW - Persons who inject drugs (PWID)

KW - Syringe exchange programs

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U2 - 10.1016/j.drugpo.2019.02.009

DO - 10.1016/j.drugpo.2019.02.009

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VL - 69

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JO - International Journal of Drug Policy

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