A novel model of care; Telemedicine and peer support for HCV care among HIV infected people who inject drugs in remote Myanmar: A retrospective study

A novel model of care; Telemedicine and peer support for HCV care among HIV infected people who inject drugs in remote Myanmar: A retrospective study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A novel model of care; Telemedicine and peer support for HCV care among HIV infected people who inject drugs in remote Myanmar: A retrospective study Ni Ni Tun, Frank Smithuis, Nyan Lynn Tun, Myo Min Min Hteik, Lutgarde Lynen, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5238109/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 24 Apr, 2026 Read the published version in Harm Reduction Journal → Version 1 posted 12 You are reading this latest preprint version Abstract Background: People who inject drugs (PWID) are at a heightened risk of co-infection with HIV and hepatitis C virus (HCV), which adversely affects health outcomes. Uncontrolled HCV can lead to increased transmission rates among PWID, highlighting the urgent need for improved access to treatment as a public health priority. Despite the availability of effective HCV treatments, access remains limited, particularly in remote areas, where stigma further complicates care. Implementing integrated and differentiated HCV care in these regions could help address this gap. This study evaluated a novel care model in remote settings, where general practitioners delivered integrated HCV-HIV care, telemonitored by specialists and supported by community health workers and peer educators. We evaluated treatment outcomes and associated predictors. Methods: We used routine program data from the HCV treatment register to assess treatment completion rates and sustained virologic response (SVR) among PWID. SVR was defined as an undetectable HCV viral load 12 weeks after treatment completion. Patients who achieved SVR were invited for retesting at one year to calculate the one-year SVR rate. Logistic regression analyses were performed to identify predictors of both SVR and one-year SVR. Results: Among 314 HIV-HCV co-infected PWID who initiated HCV treatment, 93.0% completed it, 96.2% had 12-week HCV-RNA results, and 77.9% achieved SVR. After one year, 67.7% (126 of 186) maintained SVR. Methadone maintenance therapy (aOR: 2.22; 95% CI: 1.09-4.55) and advanced liver disease—fibrosis (aOR: 2.33; 95% CI: 1.05-5.16) and cirrhosis (aOR: 3.21; 95% CI: 1.13-9.10)—were significantly linked to one-year SVR (p ≤ 0.05). Conclusion: A novel care model involving general practitioners, specialist telemonitoring, and support from community actors has shown effectiveness for most HIV-HCV co-infected PWIDs. However, further qualitative research is needed to enhance SVR rates and better understand the reasons behind incomplete follow-up. Hepatitis C virus HIV coinfection people who inject drugs treatment outcomes general practitioners community health workers peer educators remote setting. Figures Figure 1 1. Background Globally, an estimated 15.6 million adults injected drugs in 2016. Among people who inject drugs (PWID), 17.9% (2.8 million) were infected with HIV, 52.6% (8.2 million) were infected with hepatitis C virus (HCV), and approximately 8.3% (1.3 million) were co-infected with both HIV and HCV ( 1 – 3 ). In Myanmar, a major producer of opium, there are an estimated 116,000 PWIDs, among whom 19.0% are infected with HIV, 47.7% with HCV, and 20.1% of PWIDs are estimated to be infected with both HIV and HCV ( 4 , 5 ). While the introduction of effective antiretroviral therapy (ART) has improved survival among HIV-infected individuals, HCV-associated mortality remained high in HIV-HCV-coinfected patients ( 6 , 7 ). The World Health Organization (WHO) has recommended direct-acting antiviral agents (DAAs) for HCV treatment since 2018 ( 8 ). A systematic review has highlighted that DAAs can achieve a sustained viral response (SVR), undetectable HCV-RNA at 12 weeks after the completion of HCV treatment in more than 90% of patients with chronic HCV infection. Among those with very advanced stages of cirrhosis, SVR was slightly lower and ranged from 78–87% ( 9 ). Although a review of clinical trials showed SVR rates of 95–100% with DAAs among HIV-HCV coinfected general populations, the number of studies in HIV-HCV coinfected PWID was very limited ( 10 ). Regarding recurrence after SVR, a meta-analysis has shown that the overall rate of HCV recurrence was 5.9/100 person-years (95% CI 4.1–8.5) among people with recent drug use (injecting or non-injecting) ( 11 ). Evidence has shown that HCV-associated liver disease, including fibrosis, cirrhosis, and end-stage liver disease (ESLD), progresses more rapidly in HIV-HCV co-infected individuals ( 12 ). Moreover, given the high transmission risks among PWID, ensuring access to treatment for both infections is a critical public health concern. Few HCV-infected PWIDs have access to HCV treatment globally. The stigmatisation of co-infection with both HIV and HCV, alongside injecting drug use, can exacerbate barriers to HCV treatment access, lead to delayed diagnosis, and ultimately raise mortality rates. Uncontrolled HCV leads to high transmission rates among PWID ( 13 , 14 ). The urgent need for strategies that reduce stigma and enhance the acceptability of healthcare delivery to improve access to HCV care among PWID is evident ( 15 ). A multi-country survey highlighted that embedding HCV services in community-based harm reduction centres improved access to HCV care among PWID ( 16 ). In Myanmar, PWID has been a priority population for HCV elimination since 2017 ( 5 ). Nevertheless, treatment access remains limited in Myanmar, particularly in remote areas, with a yearly treatment uptake of less than 1% in HCV-positive PWIDs ( 5 , 13 , 17 ). Murdock and colleagues recommended a novel approach whereby HCV treatment is provided together with other harm reduction services, including prevention and care for HIV, other sexually transmitted infections (STI) and tuberculosis (TB), needle and syringe exchange (NSE), and opiate substitution therapy (OST) in community settings ( 10 ). Along these lines, Medical Action Myanmar (MAM), a non-government organisation (NGO) working in Myanmar, initiated a novel HCV treatment program for HIV-HCV coinfected PWID, integrated with other harm reduction services, in a remote community-based HIV clinic. The program, managed by general practitioners (GPs), telemonitored by specialists, and supported by community health workers (CHWs) and peer educators (PEs), may represent a comprehensive and promising strategy in the fight against HCV among HIV-HCV coinfected PWID. This harm reduction model of care for PWID, including a comprehensive package of services, with NSE, naloxone injection, HIV testing and treatment, HCV testing and treatment, has been described in a field note ( 18 ). To our knowledge, no previous study assessed HCV treatment outcomes among the specific group of HIV-HCV coinfected PWID, managed by GP’s with the support of telemonitoring, CHWs and PEs. We conducted a retrospective analysis of HCV treatment outcomes among HIV-HCV co-infected people who inject drugs (PWID) enrolled in MAM's integrated HIV-HCV program. We examined the predictors of SVR and one-year SVR, an undetectable HCV viral load one year after achieving SVR, approximately 15 months after completing treatment and discussed how our outcomes compare with those observed in other settings. 2. Methods 2.1. Study setting and procedure The study took place within MAM's HIV prevention and treatment program in Putao district, Kachin state, Myanmar. Putao is a remote district in northern Myanmar. Most people in Putao rely on agriculture (including opioid cultivation) and work in gold mines, where a growing number of migrant workers work ( 19 ). Heroin injection is common in Putao, particularly among miners and in rural communities ( 20 ). Access to health services for PWID is exceptionally challenging due to remoteness, poor road infrastructure and lack of public transport. MAM set up the first CHW program in Putao 2014 to provide malaria, TB, and primary health care services to remote communities. The effectiveness of MAM’s CHW-based malaria program has been demonstrated elsewhere ( 21 ). The details of the different phases of MAM services in Putao has been published ( 18 ) and are briefly presented in Table 1 . HCV diagnosis and Treatment MAM followed the Myanmar Ministry of Health national guidelines for HCV diagnosis and treatment ( 17 ). First, clients were tested with a rapid diagnostic test detecting HCV antibodies to diagnose HCV infection. Those with a positive rapid test were referred for quantitative molecular testing using GeneXpert to confirm HCV infection. Sofosbuvir (SOF) 400 mg plus Daclatasvir (DCV) 60/90 mg or SOF 400 mg plus Velpatasvir (VEL) 100 mg were used for treatment, which on average takes three to six months. Most (96%) patients were treated with SOF 400 mg plus DCV 60/90 mg. Some (4%) were treated with SOF 400 mg plus VEL 100 mg, depending on availability of drugs. MAM assessed the cirrhosis stage with the aspartate transferase (AST) to platelet ratio index (APRI) score and assessed renal function with the plasma creatinine test. SOF/VEL was recommended for 12 weeks regardless of cirrhosis status, while SOF + DCV was extended to 24 weeks if the patient was cirrhotic. Sustained viral response (SVR) was defined as an undetectable HCV viral load 12 weeks after treatment completion. All patients who achieved SVR were invited to return one year later (approximately 15 months after treatment completion) to recheck their HCV-RNA to diagnose HCV recurrence or otherwise confirm one-year SVR. Table 1 The phases of MAM services with timelines. Phases Period Details 1. The first CHW services for Malaria and TB 2014–2018 MAM set up the first CHW program in Putao to provide malaria, TB, and primary health care services to remote communities. 2. HIV and harm reduction services were added to the clinic and CHW 2018–2020 MAM started an HIV and primary healthcare clinic staffed by GPs, nurses, and peer counsellors, who provided HIV, TB, and STI counselling, testing and treatment, NSE supply, and referral for OST to the public hospital. The existing MAM's Malaria-TB program CHWs were trained to provide NSE, administer naloxone, offer health education related to harm reduction, refer individuals for HIV counselling/testing/OST, and conduct home visits to monitor PWID. MAM also selected, trained, and provided a small incentive to peer volunteers, who provided peer support, health education, and NSE to PWIDs and acted as facilitators between CHW and PWIDs. MAM also set up a mobile medical team with a doctor and PWID PE. The mobile team provided clinic services for PWID and villagers in the communities, including basic health care, family planning, HIV/HCV/STI/TB testing and referrals. The Mobile team also conducted on-the-job training for CHWs and peer volunteers. 3. HCV services were added to the clinic and CHWs 2020 onwards MAM introduced HCV treatment at the clinic. Before 2020, HCV treatment was not available in Putao. CHWs and PEs provided HCV adherence counselling and monitoring during home visits. A hepatologist from the Hepatitis B Free Foundation, an Australia-based NGO, trained GPs and monitored them weekly via Zoom. CHW, community health workers, HCV, hepatitis C virus, GPs, general practitioners, MAM, Medical Action Myanmar, NGO, non-government organisation, NSE, needle and syringe exchange, OST, oral substitution therapy, PWID, people who inject drugs, STI, sexually transmitted infection, TB, tuberculosis. 2.2. Study design, population, and period We retrospectively analysed routinely collected data from PWIDs who initiated HCV treatment between October 2020 and March 2022. The analysis included individuals who were: a) aged 18 years or older, b) HIV positive, c) injecting drugs or had a history of injecting drugs in the past 12 months, d) HCV-treatment naive, e) on antiretroviral therapy (ART), and f) who tested positive for HCV-RNA. The database was closed on September 30, 2023. 2.3. Study variables The study used routine program data collected from HCV patients' forms. Values recorded during HCV initiation visits were considered as baseline for age, current or interrupted intravenous drug use, taking or not taking methadone maintenance therapy (MMT), APRI score, ART regimen, WHO clinical staging, HIV viral load and HCV viral load. We defined baseline HIV and HCV viral load as those measured on the date closest to initiation of HCV treatment. An APRI score of 1.5 defined no cirrhosis, fibrosis or risk of cirrhosis and cirrhosis, respectively. The definitions of outcome variables are shown in Table 2 . Table 2 The outcome variables Outcome Definitions Sustained viral response (SVR) A patient who had an undetectable HCV viral load at 12 weeks after the completion of HCV treatment. Treatment failure A patient who had a detectable HCV viral load 12 weeks after the completion of HCV treatment. Death A patient who died with any cause of death, either before completing treatment or after treatment completion and before the 12-week HCV result. Lost to follow-up (LTFU) A patient who was delayed for three months or more since the planned appointment date, either before completing treatment or after treatment completion and before the 12-week HCV result, for instance, due to imprisonment. Transferred out (TO) A patient who was transferred out to a non-MAM facility, either before completing treatment or after treatment completion and before the 12-week HCV result. One-year SVR A patient who had an undetectable HCV viral load one year after achieving SVR, approximately 15 months after completing treatment. HCV recurrence A patient who had a detectable HCV viral load one year after achieving SVR, approximately 15 months after completing treatment. Death-after SVR A patient who died with any cause of death after achieving SVR and before completing a one-year follow-up after SVR. LTFU-after SVR A patient who was delayed for three months or more since the planned appointment date after achieving SVR and before completing a one-year follow-up after SVR, for instance, due to imprisonment. TO-after SVR A patient who was transferred out to a non-MAM facility after achieving SVR and before completing a one-year follow-up after SVR. Missed for one year HCV-RNA testing after SVR A patient who achieved SVR and was under the routine HIV follow-up of the clinic but missed HCV testing one year after achieving SVR. HCV; hepatitis C virus, MAM; Medical Action Myanmar, SVR; sustained viral response. 2.4. Data collection and management Any identified HCV-RNA-positive HIV patient at a MAM clinic received a numeric code (HCV code). Medical doctors and counsellors updated paper-based HCV patient files, routinely entered into the HCV database by trained data clerks. CHWs updated individual HCV case forms, which included treatment information. CHWs used a referral form to communicate with the clinic team about patients who experienced side effects, treatment adherence issues, or other problems. No directly identifying information was recorded on any of the HCV-related forms or in the HCV database. The HCV code was used for all medical communication, including linking laboratory results and communication with CHWs. HCV patients received a separate study code before data were extracted into Microsoft Excel to create the study database. The key to linking study codes with HCV codes was password protected and only accessible to the first author. If discrepancies between the HCV database and patient files were detected, original records were verified, and corrections were made. The first author conducted data cleaning and verification. 2.5. Data analysis Stata Statistical Software (Version 18.0, Stata Corp, Texas 77845 USA) was used for all analyses. Medians and interquartile ranges (IQR) were calculated for numeric variables and proportions for categorical variables. Bivariable and multivariable logistic regression analyses were used to estimate the association between various explanatory variables and SVR and one-year SVR. Patients not evaluated for SVR and one-year SVR were excluded from the respective analyses. Crude and adjusted odds ratios (OR and aOR) and 95% confidence intervals (CI) were reported. We used the Akaike Information Criterion (AIC), a mathematical method. AIC was calculated from the number of independent variables used to build the model and the maximum likelihood estimate of the model (i.e. how well the model reproduces the data). The best-fit model with the lowest AIC score was selected. The P-value of ≤ 0.05 was defined as statistically significant. 3. Ethics statement This was a retrospective analysis of routinely collected data; no informed consent was sought. The Ministry of Health, Myanmar, approved the program design and treatment protocols in July 2020. Ethical clearance was obtained from the Institutional Review Board of the Institute of Tropical Medicine, Antwerp, Belgium (Reference: IRB/RR/AC/014 1743/24). The Oxford Tropical Research Ethics Committee of the University of Oxford granted a consent waiver and an exemption from ethical review. 4. Results 4.1. Baseline characteristics The baseline characteristics of 314 patients who initiated HCV treatment between October 2020 and March 2022 are shown in Table 1 . All 314 patients were male, since most of the drug users in the region are men, and the median age was 30 (interquartile range:25–37 years). Table 1 Baseline characteristics of 314 patients initiated on DAA. Characteristic N % Sex Female 0 0.0 Male 314 100.0 Age in years 18–24 68 22.0 25–59 245 78.0 ≥ 60 1 0.0 Drug use status Active 171 54.0 Not active 143 46.0 MMT Yes 90 29.0 No 224 71.0 Employment Yes 297 95.0 No 17 5.0 Marital status Not married 179 57.0 Married 135 43.0 WHO clinical staging of HIV Stage 1 66 21.0 Stage 2 22 7.0 Stage 3 206 66.0 Stage 4 20 6.0 HIV viral load (copies/ml) (n = 312) 0 255 82.0 1-199 47 15.0 201–499 8 2.0 500–1000 2 1.0 ART regimen TDF/3TC/EFV 198 63.0 TDF/3TC/DTG 115 37.0 ABC/3TC/DTG 1 0.0 HCV viral load (copies/ml) 0-100,000 64 20.0 100,000-500,000 42 14.0 > 500,000 208 66.0 APRI score 1.5 51 16.0 HCV treatment regimen Sofosbuvir + Daclatasvir 301 96.0 Sofosbuvir + Velpatasvir 13 4.0 3TC; lamivudine, ABC; abacavir, APRI score; aspartate transferase and platelet count ratio index score, ART; antiretroviral therapy, DAA; direct-acting antiviral, DTG; dolutegravir, EFV; efavirenz, HCV; hepatitis C virus, MMT; methadone maintenance therapy, PWID; people who inject drugs, TDF; tenofovir disoproxil fumarate. “Active drug use” included PWIDs who were injecting drugs at the time of HCV treatment initiation, and “Not active drug use” included those who were not injecting drugs at the time of HCV treatment initiation but had a history of injecting drugs in the past 12 months. 4.2. HCV treatment outcomes Among 314 HIV-HCV coinfected PWID who initiated HCV treatment, 93.0% completed treatment. Of those, 96.2% received a 12-week HCV-RNA result, and 77.9% achieved SVR. At one-year follow-up among those with SVR, 67.7% (126/186) had one-year SVR. The detailed outcomes are shown in Fig. 1 . DAA; direct-acting antiviral, HCV; hepatitis C virus, up, RNA; ribonucleic acid, SVR; sustained viral response, missed for testing of one year HCV-RNA after SVR result includes patients who achieved SVR and was under the routine HIV follow-up of the clinic but missed HCV-RNA testing one year after achieving SVR. Stopped for other reasons, including the patients in which the HCV treatment was stopped for either patients’ request or for initiating rifampicin, including anti-tuberculosis treatment. 4.3. Predictors of sustained viral response In bivariable analysis, apart from age, no variable was significantly associated with SVR. The association between age and SVR was no longer significant when adjusted for other baseline factors (Table 2 ). Table 2 Predictors of SVR among 281 HIV/HCV coinfected PWID who completed HCV treatment and had an HCV-RNA result Variable Bivariable regression€ HCV-RNA tested (N) SVR (N, %) OR p-value 95% CI Age 1.05 0.02 0.01–1.09 Drug use status Active PWID 155 40 ( 26 ) Ref Not active PWID 126 22 ( 17 ) 1.64 0.10 0.92–2.95 MMT No 200 49 ( 25 ) Ref Yes 81 13 ( 16 ) 1.70 0.13 0.86–3.33 HCV viral load (copies/ml) 0-100,000 58 13 ( 22 ) Ref 100,001-500,000 34 5 ( 15 ) 1.67 0.37 0.54–5.20 > 500,000 189 44 ( 23 ) 0.95 0.89 0.47–1.92 APRI score 1.5 44 5 ( 11 ) 2.50 0.10 0.84–7.40 ART regimen TDF/3TC/EFV 178 39 ( 22 ) Ref TDF/3TC/DTG 102 23 ( 23 ) 0.96 0.90 0.54–1.73 ABC/3TC/DTG 1 0 1.00 HCV treatment regimen Sofosbuvir + Daclatasvir 269 (89) 59 ( 22 ) Ref Sofosbuvir + Velpatasvir 12 (92) 3 ( 25 ) 0.84 0.80 0.22–3.21 OR; Odd ratio, CI; Confident interval. 3TC; lamivudine, ABC; Abacavir, APRI score; Aspartate transferase and platelet count ratio index (APRI) score, ART; antiretroviral therapy, DAA; direct-acting antiviral, DTG; Dolutegravir, EFV; Efavirenz, HCV; Hepatitis C virus, MMT; methadone maintenance therapy, PWID; people who inject drugs. “Active PWID” included people who were injecting drugs at the time of HCV treatment initiation, and “Not active PWID” included those who were not injecting drugs at the time of HCV treatment initiation but had a history of injecting drugs in the past 12 months. € Different multivariable logistic regression models were constructed using the Akaike Information Criterion, and in the final multivariable model, which included age and drug use status, none of both factors were found to be associated with SVR (not shown in the table). 4.4. Predictors of one-year sustained viral response Predictors of one-year SVR, among 186 HIV/HCV coinfected PWID who had SVR and who presented for their one-year follow-up testing, are shown in Table 2 . People on MMT at the time of HCV treatment and those who had an APRI score of 0.5–1.5 or > 1.5 (versus APRI score < 0.5) were more likely to achieve one-year SVR in multivariable analysis. Discontinuation of injectable drug use at HCV treatment start was associated with one-year SVR in bivariable analysis but not in multivariable analysis. Table 3 Predictors of one-year SVR among 186 HIV/HCV coinfected PWID with SVR results. Variable Bivariable Multivariable $ one-year HCV-RNA tested (N) one-year SVR (No, %) OR p-value 95% CI aOR p-value 95% CI Age 0.98 0.41 0.95–1.02 0.98 0.23 0.93–1.02 Drug use status Active PWID 99 60 (61) Ref Not active PWID 87 66 (76) 2.04 0.03 1.08–3.86 MMT No 123 77 (63) Ref Ref Yes 63 49 (78) 2.09 0.04 1.04–4.20 2.22 0.03 1.09–4.55 HCV viral load (copies/ml) 0-100,000 36 25 (69) Ref 100,001-500,000 26 19 (73) 1.19 0.76 0.39–3.64 > 500,000 124 82 (66) 0.86 0.71 0.38–1.91 APRI score 1.5 36 27 (75) 2.55 0.07 0.94–6.89 3.21 0.03 1.13–9.10 ART regimen TDF/3TC/EFV 117 77 (66) Ref TDF/3TC/DTG 69 49 (71) 1.26 0.46 0.67–2.43 ABC/3TC/DTG 0 0 HCV treatment regimen Sofosbuvir + Daclatasvir 177 119 (67) Ref Sofosbuvir + Velpatasvir 9 7 (78) 1.71 0.51 0.34–8.47 OR; Odd ratio, aOR; Adjusted odd ratio, CI; Confident interval. 3TC; lamivudine, ABC; Abacavir, APRI score; Aspartate transferase and platelet count ratio index (APRI) score, ART; antiretroviral therapy, DAA; direct-acting antiviral, DTG; Dolutegravir, EFV; Efavirenz, HCV; Hepatitis C virus, MMT; methadone maintenance therapy, PWID; people who inject the drugs, TDF; tenofovir disoproxil fumarate. “Active PWID” included people who were injecting drugs at the time of HCV treatment initiation, and “Not active PWID” included those who were not injecting drugs at the time of HCV treatment initiation but had a history of injecting drugs in the past 12 months. $ Different multivariable logistic regression models were constructed, and the best-fitting model was selected using the Akaike Information Criterion (AIC). 5. Discussion This is the first study showing results of a novel model of care for HCV-HIV co-infected patients in remote Myanmar, managed at a community-based clinic by GPs, telemonitored by specialists, and supported by CHW and PE. Among HIV-HCV coinfected PWID who initiated HCV treatment, 93.0% completed DAA therapy. Of these, 96.2% received a 12-week HCV-RNA result, with 77.9% achieving SVR. At one-year follow-up, 67.7% of those with SVR remained HCV negative. Taking MMT at the time of HCV treatment initiation and increasing levels of liver disease (higher APRI score) were associated with achieving one-year SVR. Among 314 patients in our cohort who initiated DAA treatment, 93.0% completed the treatment, and of those 96.2% returned for an HCV-RNA test after 12 weeks. The EuroSIDA studies, covering 36 European countries, among HIV-HCV coinfected patients -of whom 56.1% were PWIDs-, reported a similar DAA completion rate with 94.4% (1598/1693), while only 74.8% (1195/1598) came back for an HCV RNA test after treatment completion ( 22 ). Our data suggests that decentralizing HCV care at the GP level with tele-support in remote areas is feasible and compares well with outcomes of other HCV care models in developed settings. HCV-positive PWID from Puerto Rico completed only 70% of DAA treatment, citing reasons such as lack of transportation, fear of side effects, and long waiting times with HCV treatment providers ( 22 ). A study from the Tel Aviv Sourasky Medical Center highlighted that the need for a specialist visit was the main gap in the HCV care cascade for coinfected PWID and recommended decentralising care ( 23 ). Designing and implementing new integrated approaches to meet the targeted PWID communities is essential to bridge the service gaps for PWID ( 24 ). Our study demonstrated an SVR rate of 77.9% (219/281). This outcome aligns well with findings from PWID in the HCV-infected and HIV-HCV-coinfected cohorts in Myanmar, where PWID achieved an SVR of 76.7% ( 25 ). Similarly, a cohort of HIV-HCV coinfected patients, with 73.4% PWID managed at hepatology clinics in Israel, reported an SVR of 79.2% (80/101) ( 23 ). However, clinical trials using DAA have reported higher SVR rates, ranging from 95–100% among the general HIV-HCV coinfected population ( 26 ). Many factors are at play. The choice of DAA regimen, patient and population characteristics, injectable drug use, OST use, HCV genotype, and liver fibrosis stage explain differences in SVR rates ( 23 , 25 , 27 – 29 ). Our study also highlighted that 67.7% (126/186) remained HCV-RNA negative one year after achieving SVR. Notably, being on MMT at the time of HCV treatment initiation significantly lowered the risk of recurrence in our cohort. However, a systematic review highlighted the importance of recent drug use regardless of OST status on HCV recurrence rates among PWID. Across 36 studies, the review found that HCV recurrence was higher among those with recent drug use, whether they were receiving OST (aRR 3.50; 95% CI 1.62–7.53) or not (aRR 3.96; 95% CI 1.82–8.59), compared to those on OST without recent drug use. ( 11 ). Our results underscore the importance of implementing the DAA program in conjunction with other harm reduction services, including drug use counselling, OST and NSP ( 11 , 30 ), to maximise the impact of HCV treatment and reduce the risk of recurrence. In our study, HCV-HIV coinfected PWIDs with APRI scores indicating higher levels of liver disease (fibrosis, cirrhosis) at the time of HCV treatment initiation had a higher likelihood of achieving one-year SVR. However, a contrasting finding was reported in a study from Taiwan, where coinfected PWIDs with a history of cirrhosis at the time of treatment initiation were associated with an increased risk of recurrence ( 31 ). Since non-invasive liver disease assessments among PWIDs have been shown to promote positive health outcomes, we hypothesise that PWIDs in our cohort became more aware of the condition of their liver during the liver staging assessment at HCV treatment initiation. This increased awareness may have contributed to changes in their lifestyle, substance use behaviour, or treatment adherence, ultimately influencing their health outcomes ( 32 ). There are several limitations to consider when interpreting our results. Since it is a retrospective study, we cannot estimate the causal effect of MMT on one-year SVR. Due to budget constraints, we could do the HCV-RNA follow-up testing only once, about 12 months after SVR, and we were unable to calculate the HCV reinfection rate per 100 person-years among those with SVR. Additionally, because of budget constraints, we could not perform next-generation sequencing (NGS) phylogenetic analysis and could not distinguish between relapse or reinfection. Though poor pill compliance among HCV-positive-PWID was a significant factor in treatment failure in another study ( 33 ), we were not able to assess its effect in our analysis due to missing data. However, our study has notable strengths. It is the first to analyse real-life experiences in remote settings managed by GPs, telemonitored by specialists, and supported with integrated CHW and PE in Myanmar. The first author initiated the program and was deeply involved in its operations, including patient management, the prospective collection of program data, and source file review to address any missing data or uncertainties. This close involvement instils confidence in the accuracy of the database, reflecting the reality of the program. 6. Conclusion Our study confirms that a novel model of decentralising HCV treatment at the community level is feasible and effective in addressing gaps in the HCV care continuum for coinfected PWIDs. This model demonstrates the potential to bridge treatment gaps and advocates for its adoption in similar settings. However, a more in-depth understanding of the reasons for not completing follow-up is necessary to further improve SVR and one-year SVR. Declarations Author Contribution NNT and FS conceived the idea, designed the program, and conducted the program.FS supervised the program and data acquisition. NNT, MMMH and NLT performed data acquisition and analysis. TD and TG supported the statistical analysis. NNT drafted the first version of the manuscript and prepared the figures and tables.All authors reviewed and approved the manuscript. Acknowledgement We would like to thank the study persons, the medical and data teams from Medical Action Myanmar and the Myanmar Oxford Clinical Research Unit, Yangon, Myanmar. Data Availability Data is provided within the manuscript with Figure and Tables. References World Health Organization. Global HIV, Hepatitis and STIs Programmes; People who inject drugs. 2020 Available from: https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/populations/people-who-inject-drugs. [accessed 10 October 2024]. Degenhardt L, Peacock A, Colledge S, et al. Global prevalence of injecting drug use and sociodemographic characteristics and prevalence of HIV, HBV, and HCV in people who inject drugs: a multistage systematic review. Lancet Glob Health. 2017 Dec;5(12):e1192-e1207. doi: 10.1016/S2214-109X(17)30375-3. Epub 2017 Oct 23. Erratum in: Lancet Glob Health. 2018 Jan;6(1):e36. doi: 10.1016/S2214-109X(17)30446-1. PMID: 29074409; PMCID: PMC5683738. World Health Organization. Hepatitis C; key facts 9 April 2024. Available from: https://www.who.int/news-room/fact-sheets/detail/hepatitis-c. [accessed 10 October 2024]. Joint United Nations Programme on HIV/AIDS. Myanmar Country Data 2023. Available from https://www.aidsdatahub.org/resource/myanmar-country-data-2023. [accessed 10 October 2024]. National Hepatitis Control Program. Ministry of Health and Sports, Myanmar. National Strategic Plan on Viral Hepatitis 2016-2020. Available from https://www.aidsdatahub.org/resource/myanmar-national-strategic-plan-viral-hepatitis-2016-2020. [accessed 10 October 2024]. Chen TY, Ding EL, Seage Iii GR, Kim AY. Meta-analysis: increased mortality associated with hepatitis C in HIV-infected persons is unrelated to HIV disease progression. Clin Infect Dis. 2009 Nov 15;49(10):1605-15. doi: 10.1086/644771. PMID: 19842982; PMCID: PMC2805261. Jia, J., Zhu, Q., Deng, L et al. Treatment outcomes of HIV patients with hepatitis B and C virus co-infections in Southwest China: an observational cohort study. Infect Dis Poverty 11, 7 (2022). https://doi.org/10.1186/s40249-021-00921-5 World Health Organization. Guidelines for the care and treatment of persons diagnosed with chronic hepatitis C virus infection, July 2018. Available from: https://apps.who.int/iris/bitstream/handle/10665/273174/9789241550345-eng.pdf?ua=1.[Accessed 10 October 2024]. Falade-Nwulia O, Suarez-Cuervo C, Nelson DR et al. Oral Direct-Acting Agent Therapy for Hepatitis C Virus Infection: A Systematic Review. Ann Intern Med. 2017 May 2;166(9):637-648. doi: 10.7326/M16-2575. Epub 2017 Mar 21. PMID: 28319996; PMCID: PMC5486987. Murdock RM, Brizzi MB, Perez O, Badowski ME. Public Health Considerations among People who Inject Drugs with HIV/HCV Co-Infection: A Review. Infect Dis Ther. 2019 Mar;8(1):23-32. doi: 10.1007/s40121-018-0228-8. Epub 2019 Jan 3. PMID: 30607808; PMCID: PMC6374239. Hajarizadeh B, Cunningham EB, Valerio H et al. Hepatitis C reinfection after successful antiviral treatment among people who inject drugs: A meta-analysis. J Hepatol. 2020 Apr;72(4):643-657. doi: 10.1016/j.jhep.2019.11.012. Epub 2019 Nov 27. PMID: 31785345. Operskalski EA, Kovacs A. HIV/HCV co-infection: pathogenesis, clinical complications, treatment, and new therapeutic technologies. Curr HIV/AIDS Rep. 2011 Mar;8(1):12-22. doi: 10.1007/s11904-010-0071-3. PMID: 21221855; PMCID: PMC3035774. Luhmann N, Champagnat J, Golovin S, Maistat L, Agustian E, Inaridze I, Myint WM, Butsashvili M, Bouscaillou J. Access to hepatitis C treatment for people who inject drugs in low and middle income settings: Evidence from 5 countries in Eastern Europe and Asia. Int J Drug Policy. 2015 Nov;26(11):1081-7. doi: 10.1016/j.drugpo.2015.07.016. Epub 2015 Aug 22. PMID: 26342273. World Health Organization. Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations July 2014. Available from: http://apps.who.int/iris/bitstream/10665/128048/1/9789241507431_eng.pdf?ua=1[Accessed 10 October 2024]. Harris, M., Rhodes, T. Hepatitis C treatment access and uptake for people who inject drugs: a review mapping the role of social factors. Harm Reduct J 10, 7 (2013). https://doi.org/10.1186/1477-7517-10-7 Di Ciaccio, M., Villes, V., Perfect, C. et al. Need for integration of hepatitis C (HCV) services in community-based settings for people who inject drugs: results from a global values and preferences survey. Harm Reduct J 20, 15 (2023). https://doi.org/10.1186/s12954-023-00743-8 National Hepatitis Control Program. Ministry of Health and Sports. Myanmar. Simplified Treatment Guidelines for Hepatitis C infection: Myanmar. February 2017. Available from https://www.aidsdatahub.org/resource/simplified-treatment-guidelines-hepatitis-c-infection-myanmar [Accessed 10 October 2024]. Tun N, Oo CL, Nwe CM, Lynen L, Decroo T, Smithuis F, Gils T. Improving access to integrated community-based HIV, HCV and harm reduction services for people who inject drugs in Putao district, North Myanmar. J Int AIDS Soc. 2024 Sep;27(9):e26355. doi: 10.1002/jia2.26355. PMID: 39267362; PMCID: PMC11393298. United Nations Office on Drugs and Crime Southeast Asia Opium Survey 2023. Cultivation, Production, and Implications. Available from https://www.unodc.org/roseap/uploads/documents/Publications/2023/ Southeast _Asia_Opium_Survey_2023.pdf. [Accessed 10 October 2024]. Joint United Nations Programme on HIV/AIDS. FEATURE STORY. Community members are driving the AIDS response in northern Myanmar. 2020; Available from: https://www.unaids.org/en/resources/presscentre/featurestories/2020/march/20200326_myanmar. [Accessed 10 October 2024]. McLean ARD, Wai HP, Thu AM et al. Malaria elimination in remote communities requires integration of malaria control activities into general health care: an observational study and interrupted time series analysis in Myanmar. BMC Med. 2018 Oct 22;16(1):183. doi: 10.1186/s12916-018-1172-x. PMID: 30343666; PMCID: PMC6196466. Amele S, Peters L, Sluzhynska M et al; EuroSIDA study group. Establishing a hepatitis C continuum of care among HIV/hepatitis C virus-coinfected individuals in EuroSIDA. HIV Med. 2019 Apr;20(4):264-273. doi: 10.1111/hiv.12711. Epub 2019 Feb 8. PMID: 30734998. Bar N, Bensoussan N, Rabinowich L et al. Barriers and Facilitators of Hepatitis C Care in Persons Coinfected with Human Immunodeficiency Virus. Int J Environ Res Public Health. 2022 Nov 18;19(22):15237. doi: 10.3390/ijerph192215237. PMID: 36429957; PMCID: PMC9690547. European Monitoring Centre for Drugs and Drug Addiction. Hepatitis C : new models of care for drugs services. 2019. Available from: http://www.emcdda.europa.eu/system/files/attachments/11482/Hepatitis-C-new-models-of-care-for-drugs-services_WEB.pdf Min Thaung Y, Chasela CS, Chew KW et al.Treatment outcomes and costs of a simplified antiviral treatment strategy for hepatitis C among monoinfected and HIV and/or hepatitis B virus-co-infected patients in Myanmar. J Viral Hepat. 2021 Jan;28(1):147-158. doi: 10.1111/jvh.13405. Epub 2020 Oct 9. PMID: 32935438; PMCID: PMC7746582. Murdock RM, Brizzi MB, Perez O, Badowski ME. Public Health Considerations among People who Inject Drugs with HIV/HCV Co-Infection: A Review. Infect Dis Ther. 2019 Mar;8(1):23-32. doi: 10.1007/s40121-018-0228-8. Epub 2019 Jan 3. PMID: 30607808; PMCID: PMC6374239. Chen CY, Huang CF, Cheng PN et al. Factors associated with treatment failure of direct-acting antivirals for chronic hepatitis C: A real-world nationwide hepatitis C virus registry programme in Taiwan. Liver Int. 2021 Jun;41(6):1265-1277. doi: 10.1111/liv.14849. Epub 2021 Mar 12. PMID: 33655714; PMCID: PMC8252422. Nguyen Thi Thu P, Ngo Thi Quynh M, Pham Van L, Nguyen Van H, Nguyen Thanh H. Determination of Risk Factors Associated with the Failure of 12 Weeks of Direct-Acting Antiviral Therapy in Patients with Hepatitis C: A Prospective Study. Biomed Res Int. 2022 May 6;2022:6054677. doi: 10.1155/2022/6054677. PMID: 35572735; PMCID: PMC9106452. Basoulis D, Mastrogianni E, Eliadi I, Papadopoulou M, Psichogiou M. HCV-HIV co-infection in people who inject drugs: Barriers to treatment and cure of HCV infection in the era of DAAs, a prospective study in Athens, Greece. HIV Med. 2024 Oct;25(10):1135-1144. doi: 10.1111/hiv.13681. Epub 2024 Jun 20. PMID: 39031579. Dore GJ. HCV reinfection as a positive indication of high-risk population treatment access. J Viral Hepat. 2019 May;26(5):516-518. doi: 10.1111/jvh.13092. Epub 2019 Mar 19. PMID: 30803082. Cheng CY, Ku SY, Lin YC, Chen CP, Cheng SH, Lin IF. Incidence and Risk Factors of Reinfection with HCV after Treatment in People Living with HIV. Viruses. 2022 Feb 21;14(2):439. doi: 10.3390/v14020439. PMID: 35216032; PMCID: PMC8874599. Litwin AH, Tsui JI, Heo M, et al. Hepatitis C Virus Reinfection Among People Who Inject Drugs: Long-Term Follow-Up of the HERO Study. JAMA Netw Open. 2024;7(8):e2430024. doi:10.1001/jamanetworkopen.2024.30024. Akiyama MJ, Riback LR, Nyakowa M, et al. Predictors of hepatitis C cure among people who inject drugs treated with directly observed therapy supported by peer case managers in Kenya. International Journal of Drug Policy. Volume 113. March 2023. doi:10.1016/j.drugpo.2023.103959. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 24 Apr, 2026 Read the published version in Harm Reduction Journal → Version 1 posted Editorial decision: Revision requested 08 Sep, 2025 Reviews received at journal 27 Aug, 2025 Reviewers agreed at journal 07 Aug, 2025 Reviews received at journal 09 Mar, 2025 Reviewers agreed at journal 23 Feb, 2025 Reviewers agreed at journal 19 Feb, 2025 Reviewers agreed at journal 22 Oct, 2024 Reviewers agreed at journal 21 Oct, 2024 Reviewers invited by journal 19 Oct, 2024 Editor assigned by journal 11 Oct, 2024 Submission checks completed at journal 11 Oct, 2024 First submitted to journal 10 Oct, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5238109","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":364955259,"identity":"4acd56fd-33a3-45fc-b1bb-456676350a74","order_by":0,"name":"Ni Ni Tun","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAm0lEQVRIiWNgGAWjYDACZgaGAx9I1nJwBukW8ZCk3Jyd9+Bh2xy7aAb23scvGHO2EdZi2cyXcDh3W3JuA89xMwvGbbcJazE4zGMA1MKc2yCRxmZAvBbLbfWkamHcdhikhfkB0VoO9m47ntvGc4yNIZEoLefPGH/4ua06t5+9jfnDR2K0wAEbEEkkkKABDJhJTDijYBSMglEwUgAAPGs4UzBBnCIAAAAASUVORK5CYII=","orcid":"","institution":"University of Antwerp","correspondingAuthor":true,"prefix":"","firstName":"Ni","middleName":"Ni","lastName":"Tun","suffix":""},{"id":364955260,"identity":"8376564c-b648-40d5-b556-8a4160ffd03e","order_by":1,"name":"Frank Smithuis","email":"","orcid":"","institution":"Myanmar Oxford Clinical Research Unit","correspondingAuthor":false,"prefix":"","firstName":"Frank","middleName":"","lastName":"Smithuis","suffix":""},{"id":364955261,"identity":"36c16b46-5d95-42f5-83e2-dd92c0ff263e","order_by":2,"name":"Nyan Lynn Tun","email":"","orcid":"","institution":"Myanmar Oxford Clinical Research Unit","correspondingAuthor":false,"prefix":"","firstName":"Nyan","middleName":"Lynn","lastName":"Tun","suffix":""},{"id":364955262,"identity":"94b872ce-72b6-473b-93a3-beb17342d5b2","order_by":3,"name":"Myo Min Min Hteik","email":"","orcid":"","institution":"Myanmar Oxford Clinical Research Unit","correspondingAuthor":false,"prefix":"","firstName":"Myo","middleName":"Min Min","lastName":"Hteik","suffix":""},{"id":364955263,"identity":"c1c0b6f1-0a7d-478b-a257-11d10002e399","order_by":4,"name":"Lutgarde Lynen","email":"","orcid":"","institution":"Institute of Tropical Medicine","correspondingAuthor":false,"prefix":"","firstName":"Lutgarde","middleName":"","lastName":"Lynen","suffix":""},{"id":364955264,"identity":"2a2585a4-77df-47a7-ac1d-0a54c11d7cc7","order_by":5,"name":"Christopher P. Conlon","email":"","orcid":"","institution":"University of Oxford","correspondingAuthor":false,"prefix":"","firstName":"Christopher","middleName":"P.","lastName":"Conlon","suffix":""},{"id":364955265,"identity":"9be913eb-625a-4b2c-9ff7-5b9534b2131e","order_by":6,"name":"Tinne Gils","email":"","orcid":"","institution":"Institute of Tropical Medicine","correspondingAuthor":false,"prefix":"","firstName":"Tinne","middleName":"","lastName":"Gils","suffix":""},{"id":364955266,"identity":"f044dead-fa86-48a4-9f2d-347f7166c853","order_by":7,"name":"Josefien van Olmen","email":"","orcid":"","institution":"University of Antwerp","correspondingAuthor":false,"prefix":"","firstName":"Josefien","middleName":"van","lastName":"Olmen","suffix":""},{"id":364955267,"identity":"c3364e60-7f43-4a59-bfce-4ea3d57a8b00","order_by":8,"name":"Tom Decroo","email":"","orcid":"","institution":"Institute of Tropical Medicine","correspondingAuthor":false,"prefix":"","firstName":"Tom","middleName":"","lastName":"Decroo","suffix":""}],"badges":[],"createdAt":"2024-10-10 09:08:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5238109/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5238109/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12954-026-01463-5","type":"published","date":"2026-04-24T15:58:18+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":67272184,"identity":"6a98027a-dddc-4ffa-a42c-b159761470ba","added_by":"auto","created_at":"2024-10-23 07:45:36","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":50060,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eHepatitis C treatment outcomes among HIV-HCV coinfected people who inject drugs, Putao, Myanmar.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDAA; direct-acting antiviral, HCV; hepatitis C virus, up, RNA; ribonucleic acid, SVR; sustained viral response, missed for testing of one year HCV-RNA after SVR result includes patients who achieved SVR and was under the routine HIV follow-up of the clinic but missed HCV-RNA testing one year after achieving SVR. Stopped for other reasons, including the patients in which the HCV treatment was stopped for either patients’ request or for initiating rifampicin, including anti-tuberculosis treatment.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5238109/v1/9234f372caa88e3c087fd525.png"},{"id":107929294,"identity":"4dd990d4-c256-4dfd-8c46-bb7bec08622a","added_by":"auto","created_at":"2026-04-27 16:14:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":558843,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5238109/v1/733b561d-6f21-4fe1-be2d-33efa55433b2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A novel model of care; Telemedicine and peer support for HCV care among HIV infected people who inject drugs in remote Myanmar: A retrospective study","fulltext":[{"header":"1. Background","content":"\u003cp\u003eGlobally, an estimated 15.6\u0026nbsp;million adults injected drugs in 2016. Among people who inject drugs (PWID), 17.9% (2.8\u0026nbsp;million) were infected with HIV, 52.6% (8.2\u0026nbsp;million) were infected with hepatitis C virus (HCV), and approximately 8.3% (1.3\u0026nbsp;million) were co-infected with both HIV and HCV (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). In Myanmar, a major producer of opium, there are an estimated 116,000 PWIDs, among whom 19.0% are infected with HIV, 47.7% with HCV, and 20.1% of PWIDs are estimated to be infected with both HIV and HCV (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). While the introduction of effective antiretroviral therapy (ART) has improved survival among HIV-infected individuals, HCV-associated mortality remained high in HIV-HCV-coinfected patients (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The World Health Organization (WHO) has recommended direct-acting antiviral agents (DAAs) for HCV treatment since 2018 (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). A systematic review has highlighted that DAAs can achieve a sustained viral response (SVR), undetectable HCV-RNA at 12 weeks after the completion of HCV treatment in more than 90% of patients with chronic HCV infection. Among those with very advanced stages of cirrhosis, SVR was slightly lower and ranged from 78\u0026ndash;87% (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Although a review of clinical trials showed SVR rates of 95\u0026ndash;100% with DAAs among HIV-HCV coinfected general populations, the number of studies in HIV-HCV coinfected PWID was very limited (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Regarding recurrence after SVR, a meta-analysis has shown that the overall rate of HCV recurrence was 5.9/100 person-years (95% CI 4.1\u0026ndash;8.5) among people with recent drug use (injecting or non-injecting) (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Evidence has shown that HCV-associated liver disease, including fibrosis, cirrhosis, and end-stage liver disease (ESLD), progresses more rapidly in HIV-HCV co-infected individuals (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Moreover, given the high transmission risks among PWID, ensuring access to treatment for both infections is a critical public health concern.\u003c/p\u003e \u003cp\u003eFew HCV-infected PWIDs have access to HCV treatment globally. The stigmatisation of co-infection with both HIV and HCV, alongside injecting drug use, can exacerbate barriers to HCV treatment access, lead to delayed diagnosis, and ultimately raise mortality rates. Uncontrolled HCV leads to high transmission rates among PWID (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). The urgent need for strategies that reduce stigma and enhance the acceptability of healthcare delivery to improve access to HCV care among PWID is evident (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). A multi-country survey highlighted that embedding HCV services in community-based harm reduction centres improved access to HCV care among PWID (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn Myanmar, PWID has been a priority population for HCV elimination since 2017 (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Nevertheless, treatment access remains limited in Myanmar, particularly in remote areas, with a yearly treatment uptake of less than 1% in HCV-positive PWIDs (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Murdock and colleagues recommended a novel approach whereby HCV treatment is provided together with other harm reduction services, including prevention and care for HIV, other sexually transmitted infections (STI) and tuberculosis (TB), needle and syringe exchange (NSE), and opiate substitution therapy (OST) in community settings (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Along these lines, Medical Action Myanmar (MAM), a non-government organisation (NGO) working in Myanmar, initiated a novel HCV treatment program for HIV-HCV coinfected PWID, integrated with other harm reduction services, in a remote community-based HIV clinic. The program, managed by general practitioners (GPs), telemonitored by specialists, and supported by community health workers (CHWs) and peer educators (PEs), may represent a comprehensive and promising strategy in the fight against HCV among HIV-HCV coinfected PWID. This harm reduction model of care for PWID, including a comprehensive package of services, with NSE, naloxone injection, HIV testing and treatment, HCV testing and treatment, has been described in a field note (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). To our knowledge, no previous study assessed HCV treatment outcomes among the specific group of HIV-HCV coinfected PWID, managed by GP\u0026rsquo;s with the support of telemonitoring, CHWs and PEs. We conducted a retrospective analysis of HCV treatment outcomes among HIV-HCV co-infected people who inject drugs (PWID) enrolled in MAM's integrated HIV-HCV program. We examined the predictors of SVR and one-year SVR, an undetectable HCV viral load one year after achieving SVR, approximately 15 months after completing treatment and discussed how our outcomes compare with those observed in other settings.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Study setting and procedure\u003c/h2\u003e \u003cp\u003eThe study took place within MAM's HIV prevention and treatment program in Putao district, Kachin state, Myanmar. Putao is a remote district in northern Myanmar. Most people in Putao rely on agriculture (including opioid cultivation) and work in gold mines, where a growing number of migrant workers work (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Heroin injection is common in Putao, particularly among miners and in rural communities (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Access to health services for PWID is exceptionally challenging due to remoteness, poor road infrastructure and lack of public transport. MAM set up the first CHW program in Putao 2014 to provide malaria, TB, and primary health care services to remote communities. The effectiveness of MAM\u0026rsquo;s CHW-based malaria program has been demonstrated elsewhere (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). The details of the different phases of MAM services in Putao has been published (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) and are briefly presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eHCV diagnosis and Treatment\u003c/strong\u003e \u003cp\u003eMAM followed the Myanmar Ministry of Health national guidelines for HCV diagnosis and treatment (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). First, clients were tested with a rapid diagnostic test detecting HCV antibodies to diagnose HCV infection. Those with a positive rapid test were referred for quantitative molecular testing using GeneXpert to confirm HCV infection. Sofosbuvir (SOF) 400 mg plus Daclatasvir (DCV) 60/90 mg or SOF 400 mg plus Velpatasvir (VEL) 100 mg were used for treatment, which on average takes three to six months. Most (96%) patients were treated with SOF 400 mg plus DCV 60/90 mg. Some (4%) were treated with SOF 400 mg plus VEL 100 mg, depending on availability of drugs. MAM assessed the cirrhosis stage with the aspartate transferase (AST) to platelet ratio index (APRI) score and assessed renal function with the plasma creatinine test. SOF/VEL was recommended for 12 weeks regardless of cirrhosis status, while SOF\u0026thinsp;+\u0026thinsp;DCV was extended to 24 weeks if the patient was cirrhotic. Sustained viral response (SVR) was defined as an undetectable HCV viral load 12 weeks after treatment completion. All patients who achieved SVR were invited to return one year later (approximately 15 months after treatment completion) to recheck their HCV-RNA to diagnose HCV recurrence or otherwise confirm one-year SVR.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe phases of MAM services with timelines.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhases\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePeriod\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDetails\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. The first CHW services for Malaria and TB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2014\u0026ndash;2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMAM set up the first CHW program in Putao to provide malaria, TB, and primary health care services to remote communities.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. HIV and harm reduction services were added to the clinic and CHW\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2018\u0026ndash;2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMAM started an HIV and primary healthcare clinic staffed by GPs, nurses, and peer counsellors, who provided HIV, TB, and STI counselling, testing and treatment, NSE supply, and referral for OST to the public hospital. The existing MAM's Malaria-TB program CHWs were trained to provide NSE, administer naloxone, offer health education related to harm reduction, refer individuals for HIV counselling/testing/OST, and conduct home visits to monitor PWID. MAM also selected, trained, and provided a small incentive to peer volunteers, who provided peer support, health education, and NSE to PWIDs and acted as facilitators between CHW and PWIDs. MAM also set up a mobile medical team with a doctor and PWID PE. The mobile team provided clinic services for PWID and villagers in the communities, including basic health care, family planning, HIV/HCV/STI/TB testing and referrals. The Mobile team also conducted on-the-job training for CHWs and peer volunteers.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. HCV services were added to the clinic and CHWs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2020 onwards\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMAM introduced HCV treatment at the clinic. Before 2020, HCV treatment was not available in Putao. CHWs and PEs provided HCV adherence counselling and monitoring during home visits. A hepatologist from the Hepatitis B Free Foundation, an Australia-based NGO, trained GPs and monitored them weekly via Zoom.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eCHW, community health workers, HCV, hepatitis C virus, GPs, general practitioners, MAM, Medical Action Myanmar, NGO, non-government organisation, NSE, needle and syringe exchange, OST, oral substitution therapy, PWID, people who inject drugs, STI, sexually transmitted infection, TB, tuberculosis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Study design, population, and period\u003c/h2\u003e \u003cp\u003eWe retrospectively analysed routinely collected data from PWIDs who initiated HCV treatment between October 2020 and March 2022. The analysis included individuals who were: a) aged 18 years or older, b) HIV positive, c) injecting drugs or had a history of injecting drugs in the past 12 months, d) HCV-treatment naive, e) on antiretroviral therapy (ART), and f) who tested positive for HCV-RNA. The database was closed on September 30, 2023.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Study variables\u003c/h2\u003e \u003cp\u003eThe study used routine program data collected from HCV patients' forms. Values recorded during HCV initiation visits were considered as baseline for age, current or interrupted intravenous drug use, taking or not taking methadone maintenance therapy (MMT), APRI score, ART regimen, WHO clinical staging, HIV viral load and HCV viral load. We defined baseline HIV and HCV viral load as those measured on the date closest to initiation of HCV treatment. An APRI score of \u0026lt;\u0026thinsp;0.5, 0.5 to 1.5, and \u0026gt;\u0026thinsp;1.5 defined no cirrhosis, fibrosis or risk of cirrhosis and cirrhosis, respectively. The definitions of outcome variables are shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe outcome variables\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutcome\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDefinitions\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSustained viral response (SVR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA patient who had an undetectable HCV viral load at 12 weeks after the completion of HCV treatment.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA patient who had a detectable HCV viral load 12 weeks after the completion of HCV treatment.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeath\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA patient who died with any cause of death, either before completing treatment or after treatment completion and before the 12-week HCV result.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLost to follow-up (LTFU)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA patient who was delayed for three months or more since the planned appointment date, either before completing treatment or after treatment completion and before the 12-week HCV result, for instance, due to imprisonment.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransferred out (TO)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA patient who was transferred out to a non-MAM facility, either before completing treatment or after treatment completion and before the 12-week HCV result.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOne-year SVR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA patient who had an undetectable HCV viral load one year after achieving SVR, approximately 15 months after completing treatment.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHCV recurrence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA patient who had a detectable HCV viral load one year after achieving SVR, approximately 15 months after completing treatment.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeath-after SVR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA patient who died with any cause of death after achieving SVR and before completing a one-year follow-up after SVR.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLTFU-after SVR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA patient who was delayed for three months or more since the planned appointment date after achieving SVR and before completing a one-year follow-up after SVR, for instance, due to imprisonment.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTO-after SVR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA patient who was transferred out to a non-MAM facility after achieving SVR and before completing a one-year follow-up after SVR.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMissed for one year HCV-RNA testing after SVR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA patient who achieved SVR and was under the routine HIV follow-up of the clinic but missed HCV testing one year after achieving SVR.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eHCV; hepatitis C virus, MAM; Medical Action Myanmar, SVR; sustained viral response.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4. Data collection and management\u003c/h2\u003e \u003cp\u003eAny identified HCV-RNA-positive HIV patient at a MAM clinic received a numeric code (HCV code). Medical doctors and counsellors updated paper-based HCV patient files, routinely entered into the HCV database by trained data clerks. CHWs updated individual HCV case forms, which included treatment information. CHWs used a referral form to communicate with the clinic team about patients who experienced side effects, treatment adherence issues, or other problems. No directly identifying information was recorded on any of the HCV-related forms or in the HCV database. The HCV code was used for all medical communication, including linking laboratory results and communication with CHWs. HCV patients received a separate study code before data were extracted into Microsoft Excel to create the study database. The key to linking study codes with HCV codes was password protected and only accessible to the first author. If discrepancies between the HCV database and patient files were detected, original records were verified, and corrections were made. The first author conducted data cleaning and verification.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5. Data analysis\u003c/h2\u003e \u003cp\u003eStata Statistical Software (Version 18.0, Stata Corp, Texas 77845 USA) was used for all analyses. Medians and interquartile ranges (IQR) were calculated for numeric variables and proportions for categorical variables. Bivariable and multivariable logistic regression analyses were used to estimate the association between various explanatory variables and SVR and one-year SVR. Patients not evaluated for SVR and one-year SVR were excluded from the respective analyses. Crude and adjusted odds ratios (OR and aOR) and 95% confidence intervals (CI) were reported. We used the Akaike Information Criterion (AIC), a mathematical method. AIC was calculated from the number of independent variables used to build the model and the maximum likelihood estimate of the model (i.e. how well the model reproduces the data). The best-fit model with the lowest AIC score was selected. The P-value of \u0026le;\u0026thinsp;0.05 was defined as statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Ethics statement","content":"\u003cp\u003e This was a retrospective analysis of routinely collected data; no informed consent was sought. The Ministry of Health, Myanmar, approved the program design and treatment protocols in July 2020. Ethical clearance was obtained from the Institutional Review Board of the Institute of Tropical Medicine, Antwerp, Belgium (Reference: IRB/RR/AC/014 1743/24). The Oxford Tropical Research Ethics Committee of the University of Oxford granted a consent waiver and an exemption from ethical review.\u003c/p\u003e"},{"header":"4. Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e4.1. Baseline characteristics\u003c/h2\u003e \u003cp\u003eThe baseline characteristics of 314 patients who initiated HCV treatment between October 2020 and March 2022 are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e1\u003c/span\u003e. All 314 patients were male, since most of the drug users in the region are men, and the median age was 30 (interquartile range:25\u0026ndash;37 years).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics of 314 patients initiated on DAA.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e314\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge in years\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e245\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e78.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDrug use status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eActive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot active\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e143\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMMT\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e224\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e71.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEmployment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e297\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e95.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot married\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e179\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWHO clinical staging of HIV\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStage 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStage 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStage 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e206\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStage 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHIV viral load (copies/ml) (n\u0026thinsp;=\u0026thinsp;312)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e255\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e82.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1-199\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e201\u0026ndash;499\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e500\u0026ndash;1000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eART regimen\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTDF/3TC/EFV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e198\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTDF/3TC/DTG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eABC/3TC/DTG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHCV viral load (copies/ml)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0-100,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e100,000-500,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;500,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e208\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAPRI score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0.5\u0026ndash;1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHCV treatment regimen\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSofosbuvir\u0026thinsp;+\u0026thinsp;Daclatasvir\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e301\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e96.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSofosbuvir\u0026thinsp;+\u0026thinsp;Velpatasvir\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e3TC; lamivudine, ABC; abacavir, APRI score; aspartate transferase and platelet count ratio index score, ART; antiretroviral therapy, DAA; direct-acting antiviral, DTG; dolutegravir, EFV; efavirenz, HCV; hepatitis C virus, MMT; methadone maintenance therapy, PWID; people who inject drugs, TDF; tenofovir disoproxil fumarate. \u0026ldquo;Active drug use\u0026rdquo; included PWIDs who were injecting drugs at the time of HCV treatment initiation, and \u0026ldquo;Not active drug use\u0026rdquo; included those who were not injecting drugs at the time of HCV treatment initiation but had a history of injecting drugs in the past 12 months.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e4.2. HCV treatment outcomes\u003c/h2\u003e \u003cp\u003eAmong 314 HIV-HCV coinfected PWID who initiated HCV treatment, 93.0% completed treatment. Of those, 96.2% received a 12-week HCV-RNA result, and 77.9% achieved SVR. At one-year follow-up among those with SVR, 67.7% (126/186) had one-year SVR. The detailed outcomes are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eDAA; direct-acting antiviral, HCV; hepatitis C virus, up, RNA; ribonucleic acid, SVR; sustained viral response, missed for testing of one year HCV-RNA after SVR result includes patients who achieved SVR and was under the routine HIV follow-up of the clinic but missed HCV-RNA testing one year after achieving SVR. Stopped for other reasons, including the patients in which the HCV treatment was stopped for either patients\u0026rsquo; request or for initiating rifampicin, including anti-tuberculosis treatment.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e4.3. Predictors of sustained viral response\u003c/h2\u003e \u003cp\u003eIn bivariable analysis, apart from age, no variable was significantly associated with SVR. The association between age and SVR was no longer significant when adjusted for other baseline factors (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePredictors of SVR among 281 HIV/HCV coinfected PWID who completed HCV treatment and had an HCV-RNA result\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003eBivariable regression\u0026euro;\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHCV-RNA tested (N)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSVR (N, %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.01\u0026ndash;1.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDrug use status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eActive PWID\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot active PWID\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.92\u0026ndash;2.95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMMT\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49 (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.86\u0026ndash;3.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHCV viral load (copies/ml)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0-100,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e100,001-500,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.54\u0026ndash;5.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;500,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e189\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44 (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.47\u0026ndash;1.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAPRI score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0.5\u0026ndash;1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41 (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.52\u0026ndash;1.97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.84\u0026ndash;7.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eART regimen\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTDF/3TC/EFV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e178\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTDF/3TC/DTG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.54\u0026ndash;1.73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eABC/3TC/DTG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHCV treatment regimen\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSofosbuvir\u0026thinsp;+\u0026thinsp;Daclatasvir\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e269 (89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59 (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSofosbuvir\u0026thinsp;+\u0026thinsp;Velpatasvir\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.22\u0026ndash;3.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOR; Odd ratio, CI; Confident interval. 3TC; lamivudine, ABC; Abacavir, APRI score; Aspartate transferase and platelet count ratio index (APRI) score, ART; antiretroviral therapy, DAA; direct-acting antiviral, DTG; Dolutegravir, EFV; Efavirenz, HCV; Hepatitis C virus, MMT; methadone maintenance therapy, PWID; people who inject drugs. \u0026ldquo;Active PWID\u0026rdquo; included people who were injecting drugs at the time of HCV treatment initiation, and \u0026ldquo;Not active PWID\u0026rdquo; included those who were not injecting drugs at the time of HCV treatment initiation but had a history of injecting drugs in the past 12 months. \u003csup\u003e\u003cb\u003e\u0026euro;\u003c/b\u003e\u003c/sup\u003e Different multivariable logistic regression models were constructed using the Akaike Information Criterion, and in the final multivariable model, which included age and drug use status, none of both factors were found to be associated with SVR (not shown in the table).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e\u003cb\u003e4.4. Predictors of one-year sustained viral response\u003c/b\u003e\u003c/h2\u003e \u003cp\u003ePredictors of one-year SVR, among 186 HIV/HCV coinfected PWID who had SVR and who presented for their one-year follow-up testing, are shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e2\u003c/span\u003e. People on MMT at the time of HCV treatment and those who had an APRI score of 0.5\u0026ndash;1.5 or \u0026gt;\u0026thinsp;1.5 (versus APRI score\u0026thinsp;\u0026lt;\u0026thinsp;0.5) were more likely to achieve one-year SVR in multivariable analysis. Discontinuation of injectable drug use at HCV treatment start was associated with one-year SVR in bivariable analysis but not in multivariable analysis.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePredictors of one-year SVR among 186 HIV/HCV coinfected PWID with SVR results.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003eBivariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003eMultivariable\u003csup\u003e$\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eone-year HCV-RNA tested (N)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eone-year SVR (No, %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eaOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.95\u0026ndash;1.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.93\u0026ndash;1.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDrug use status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eActive PWID\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60 (61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot active PWID\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66 (76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.08\u0026ndash;3.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMMT\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77 (63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49 (78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.04\u0026ndash;4.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.09\u0026ndash;4.55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHCV viral load\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(copies/ml)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0-100,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e100,001-500,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.39\u0026ndash;3.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;500,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82 (66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.38\u0026ndash;1.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAPRI score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0.5\u0026ndash;1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79 (70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.92\u0026ndash;4.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.05\u0026ndash;5.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.94\u0026ndash;6.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.13\u0026ndash;9.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eART regimen\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTDF/3TC/EFV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77 (66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTDF/3TC/DTG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49 (71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.67\u0026ndash;2.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eABC/3TC/DTG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHCV treatment regimen\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSofosbuvir\u0026thinsp;+\u0026thinsp;Daclatasvir\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e177\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e119 (67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSofosbuvir\u0026thinsp;+\u0026thinsp;Velpatasvir\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.34\u0026ndash;8.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOR; Odd ratio, aOR; Adjusted odd ratio, CI; Confident interval. 3TC; lamivudine, ABC; Abacavir, APRI score; Aspartate transferase and platelet count ratio index (APRI) score, ART; antiretroviral therapy, DAA; direct-acting antiviral, DTG; Dolutegravir, EFV; Efavirenz, HCV; Hepatitis C virus, MMT; methadone maintenance therapy, PWID; people who inject the drugs, TDF; tenofovir disoproxil fumarate. \u0026ldquo;Active PWID\u0026rdquo; included people who were injecting drugs at the time of HCV treatment initiation, and \u0026ldquo;Not active PWID\u0026rdquo; included those who were not injecting drugs at the time of HCV treatment initiation but had a history of injecting drugs in the past 12 months. \u003csup\u003e\u003cb\u003e$\u003c/b\u003e\u003c/sup\u003eDifferent multivariable logistic regression models were constructed, and the best-fitting model was selected using the Akaike Information Criterion (AIC).\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Discussion","content":"\u003cp\u003eThis is the first study showing results of a novel model of care for HCV-HIV co-infected patients in remote Myanmar, managed at a community-based clinic by GPs, telemonitored by specialists, and supported by CHW and PE. Among HIV-HCV coinfected PWID who initiated HCV treatment, 93.0% completed DAA therapy. Of these, 96.2% received a 12-week HCV-RNA result, with 77.9% achieving SVR. At one-year follow-up, 67.7% of those with SVR remained HCV negative. Taking MMT at the time of HCV treatment initiation and increasing levels of liver disease (higher APRI score) were associated with achieving one-year SVR.\u003c/p\u003e \u003cp\u003eAmong 314 patients in our cohort who initiated DAA treatment, 93.0% completed the treatment, and of those 96.2% returned for an HCV-RNA test after 12 weeks. The EuroSIDA studies, covering 36 European countries, among HIV-HCV coinfected patients -of whom 56.1% were PWIDs-, reported a similar DAA completion rate with 94.4% (1598/1693), while only 74.8% (1195/1598) came back for an HCV RNA test after treatment completion (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Our data suggests that decentralizing HCV care at the GP level with tele-support in remote areas is feasible and compares well with outcomes of other HCV care models in developed settings. HCV-positive PWID from Puerto Rico completed only 70% of DAA treatment, citing reasons such as lack of transportation, fear of side effects, and long waiting times with HCV treatment providers (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). A study from the Tel Aviv Sourasky Medical Center highlighted that the need for a specialist visit was the main gap in the HCV care cascade for coinfected PWID and recommended decentralising care (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Designing and implementing new integrated approaches to meet the targeted PWID communities is essential to bridge the service gaps for PWID (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOur study demonstrated an SVR rate of 77.9% (219/281). This outcome aligns well with findings from PWID in the HCV-infected and HIV-HCV-coinfected cohorts in Myanmar, where PWID achieved an SVR of 76.7% (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Similarly, a cohort of HIV-HCV coinfected patients, with 73.4% PWID managed at hepatology clinics in Israel, reported an SVR of 79.2% (80/101) (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). However, clinical trials using DAA have reported higher SVR rates, ranging from 95\u0026ndash;100% among the general HIV-HCV coinfected population (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Many factors are at play. The choice of DAA regimen, patient and population characteristics, injectable drug use, OST use, HCV genotype, and liver fibrosis stage explain differences in SVR rates (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan additionalcitationids=\"CR28\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOur study also highlighted that 67.7% (126/186) remained HCV-RNA negative one year after achieving SVR. Notably, being on MMT at the time of HCV treatment initiation significantly lowered the risk of recurrence in our cohort. However, a systematic review highlighted the importance of recent drug use regardless of OST status on HCV recurrence rates among PWID. Across 36 studies, the review found that HCV recurrence was higher among those with recent drug use, whether they were receiving OST (aRR 3.50; 95% CI 1.62\u0026ndash;7.53) or not (aRR 3.96; 95% CI 1.82\u0026ndash;8.59), compared to those on OST without recent drug use. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Our results underscore the importance of implementing the DAA program in conjunction with other harm reduction services, including drug use counselling, OST and NSP (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e), to maximise the impact of HCV treatment and reduce the risk of recurrence.\u003c/p\u003e \u003cp\u003eIn our study, HCV-HIV coinfected PWIDs with APRI scores indicating higher levels of liver disease (fibrosis, cirrhosis) at the time of HCV treatment initiation had a higher likelihood of achieving one-year SVR. However, a contrasting finding was reported in a study from Taiwan, where coinfected PWIDs with a history of cirrhosis at the time of treatment initiation were associated with an increased risk of recurrence (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Since non-invasive liver disease assessments among PWIDs have been shown to promote positive health outcomes, we hypothesise that PWIDs in our cohort became more aware of the condition of their liver during the liver staging assessment at HCV treatment initiation. This increased awareness may have contributed to changes in their lifestyle, substance use behaviour, or treatment adherence, ultimately influencing their health outcomes (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThere are several limitations to consider when interpreting our results. Since it is a retrospective study, we cannot estimate the causal effect of MMT on one-year SVR. Due to budget constraints, we could do the HCV-RNA follow-up testing only once, about 12 months after SVR, and we were unable to calculate the HCV reinfection rate per 100 person-years among those with SVR. Additionally, because of budget constraints, we could not perform next-generation sequencing (NGS) phylogenetic analysis and could not distinguish between relapse or reinfection. Though poor pill compliance among HCV-positive-PWID was a significant factor in treatment failure in another study (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e), we were not able to assess its effect in our analysis due to missing data. However, our study has notable strengths. It is the first to analyse real-life experiences in remote settings managed by GPs, telemonitored by specialists, and supported with integrated CHW and PE in Myanmar. The first author initiated the program and was deeply involved in its operations, including patient management, the prospective collection of program data, and source file review to address any missing data or uncertainties. This close involvement instils confidence in the accuracy of the database, reflecting the reality of the program.\u003c/p\u003e"},{"header":"6. Conclusion","content":"\u003cp\u003e Our study confirms that a novel model of decentralising HCV treatment at the community level is feasible and effective in addressing gaps in the HCV care continuum for coinfected PWIDs. This model demonstrates the potential to bridge treatment gaps and advocates for its adoption in similar settings. However, a more in-depth understanding of the reasons for not completing follow-up is necessary to further improve SVR and one-year SVR.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eNNT and FS conceived the idea, designed the program, and conducted the program.FS supervised the program and data acquisition. NNT, MMMH and NLT performed data acquisition and analysis. TD and TG supported the statistical analysis. NNT drafted the first version of the manuscript and prepared the figures and tables.All authors reviewed and approved the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe would like to thank the study persons, the medical and data teams from Medical Action Myanmar and the Myanmar Oxford Clinical Research Unit, Yangon, Myanmar.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData is provided within the manuscript with Figure and Tables.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. Global HIV, Hepatitis and STIs Programmes; People who inject drugs. 2020 Available from: https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/populations/people-who-inject-drugs. [accessed 10 October 2024].\u003c/li\u003e\n\u003cli\u003eDegenhardt L, Peacock A, Colledge S, et al. Global prevalence of injecting drug use and sociodemographic characteristics and prevalence of HIV, HBV, and HCV in people who inject drugs: a multistage systematic review. Lancet Glob Health. 2017 Dec;5(12):e1192-e1207. doi: 10.1016/S2214-109X(17)30375-3. Epub 2017 Oct 23. Erratum in: Lancet Glob Health. 2018 Jan;6(1):e36. doi: 10.1016/S2214-109X(17)30446-1. PMID: 29074409; PMCID: PMC5683738.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Hepatitis C; key facts 9 April 2024. Available from: https://www.who.int/news-room/fact-sheets/detail/hepatitis-c. [accessed 10 October 2024]. \u003c/li\u003e\n\u003cli\u003eJoint United Nations Programme on HIV/AIDS. Myanmar Country Data 2023. Available from https://www.aidsdatahub.org/resource/myanmar-country-data-2023. [accessed 10 October 2024]. \u003c/li\u003e\n\u003cli\u003eNational Hepatitis Control Program. Ministry of Health and Sports, Myanmar. National Strategic Plan on Viral Hepatitis 2016-2020. 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Available from: http://apps.who.int/iris/bitstream/10665/128048/1/9789241507431_eng.pdf?ua=1[Accessed 10 October 2024].\u003c/li\u003e\n\u003cli\u003eHarris, M., Rhodes, T. Hepatitis C treatment access and uptake for people who inject drugs: a review mapping the role of social factors. \u003cem\u003eHarm Reduct J\u003c/em\u003e 10, 7 (2013). https://doi.org/10.1186/1477-7517-10-7\u003c/li\u003e\n\u003cli\u003eDi Ciaccio, M., Villes, V., Perfect, C. \u003cem\u003eet al.\u003c/em\u003e Need for integration of hepatitis C (HCV) services in community-based settings for people who inject drugs: results from a global values and preferences survey. \u003cem\u003eHarm Reduct J\u003c/em\u003e 20, 15 (2023). https://doi.org/10.1186/s12954-023-00743-8\u003c/li\u003e\n\u003cli\u003eNational Hepatitis Control Program. Ministry of Health and Sports. Myanmar. Simplified Treatment Guidelines for Hepatitis C infection: Myanmar. February 2017. 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Community members are driving the AIDS response in northern Myanmar. 2020; Available from: https://www.unaids.org/en/resources/presscentre/featurestories/2020/march/20200326_myanmar. [Accessed 10 October 2024].\u003c/li\u003e\n\u003cli\u003eMcLean ARD, Wai HP, Thu AM et al. Malaria elimination in remote communities requires integration of malaria control activities into general health care: an observational study and interrupted time series analysis in Myanmar. BMC Med. 2018 Oct 22;16(1):183. doi: 10.1186/s12916-018-1172-x. PMID: 30343666; PMCID: PMC6196466. \u003c/li\u003e\n\u003cli\u003eAmele S, Peters L, Sluzhynska M et al; EuroSIDA study group. Establishing a hepatitis C continuum of care among HIV/hepatitis C virus-coinfected individuals in EuroSIDA. HIV Med. 2019 Apr;20(4):264-273. doi: 10.1111/hiv.12711. Epub 2019 Feb 8. PMID: 30734998.\u003c/li\u003e\n\u003cli\u003eBar N, Bensoussan N, Rabinowich L et al. Barriers and Facilitators of Hepatitis C Care in Persons Coinfected with Human Immunodeficiency Virus. Int J Environ Res Public Health. 2022 Nov 18;19(22):15237. doi: 10.3390/ijerph192215237. PMID: 36429957; PMCID: PMC9690547. \u003c/li\u003e\n\u003cli\u003eEuropean Monitoring Centre for Drugs and Drug Addiction. Hepatitis C : new models of care for drugs services. 2019. Available from: http://www.emcdda.europa.eu/system/files/attachments/11482/Hepatitis-C-new-models-of-care-for-drugs-services_WEB.pdf\u003c/li\u003e\n\u003cli\u003eMin Thaung Y, Chasela CS, Chew KW et al.Treatment outcomes and costs of a simplified antiviral treatment strategy for hepatitis C among monoinfected and HIV and/or hepatitis B virus-co-infected patients in Myanmar. J Viral Hepat. 2021 Jan;28(1):147-158. doi: 10.1111/jvh.13405. Epub 2020 Oct 9. PMID: 32935438; PMCID: PMC7746582.\u003c/li\u003e\n\u003cli\u003eMurdock RM, Brizzi MB, Perez O, Badowski ME. Public Health Considerations among People who Inject Drugs with HIV/HCV Co-Infection: A Review. Infect Dis Ther. 2019 Mar;8(1):23-32. doi: 10.1007/s40121-018-0228-8. Epub 2019 Jan 3. PMID: 30607808; PMCID: PMC6374239. \u003c/li\u003e\n\u003cli\u003eChen CY, Huang CF, Cheng PN et al. Factors associated with treatment failure of direct-acting antivirals for chronic hepatitis C: A real-world nationwide hepatitis C virus registry programme in Taiwan. Liver Int. 2021 Jun;41(6):1265-1277. doi: 10.1111/liv.14849. Epub 2021 Mar 12. PMID: 33655714; PMCID: PMC8252422.\u003c/li\u003e\n\u003cli\u003eNguyen Thi Thu P, Ngo Thi Quynh M, Pham Van L, Nguyen Van H, Nguyen Thanh H. Determination of Risk Factors Associated with the Failure of 12 Weeks of Direct-Acting Antiviral Therapy in Patients with Hepatitis C: A Prospective Study. Biomed Res Int. 2022 May 6;2022:6054677. doi: 10.1155/2022/6054677. PMID: 35572735; PMCID: PMC9106452.\u003c/li\u003e\n\u003cli\u003eBasoulis D, Mastrogianni E, Eliadi I, Papadopoulou M, Psichogiou M. HCV-HIV co-infection in people who inject drugs: Barriers to treatment and cure of HCV infection in the era of DAAs, a prospective study in Athens, Greece. HIV Med. 2024 Oct;25(10):1135-1144. doi: 10.1111/hiv.13681. Epub 2024 Jun 20. PMID: 39031579.\u003c/li\u003e\n\u003cli\u003eDore GJ. HCV reinfection as a positive indication of high-risk population treatment access. J Viral Hepat. 2019 May;26(5):516-518. doi: 10.1111/jvh.13092. Epub 2019 Mar 19. PMID: 30803082.\u003c/li\u003e\n\u003cli\u003eCheng CY, Ku SY, Lin YC, Chen CP, Cheng SH, Lin IF. Incidence and Risk Factors of Reinfection with HCV after Treatment in People Living with HIV. Viruses. 2022 Feb 21;14(2):439. doi: 10.3390/v14020439. PMID: 35216032; PMCID: PMC8874599. \u003c/li\u003e\n\u003cli\u003eLitwin AH, Tsui JI, Heo M, et al. Hepatitis C Virus Reinfection Among People Who Inject Drugs: Long-Term Follow-Up of the HERO Study. \u003cem\u003eJAMA Netw Open.\u003c/em\u003e 2024;7(8):e2430024. doi:10.1001/jamanetworkopen.2024.30024. \u003c/li\u003e\n\u003cli\u003eAkiyama MJ, Riback LR, Nyakowa M, et al. Predictors of hepatitis C cure among people who inject drugs treated with directly observed therapy supported by peer case managers in Kenya. International Journal of Drug Policy. Volume 113. March 2023. doi:10.1016/j.drugpo.2023.103959. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"harm-reduction-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"harj","sideBox":"Learn more about [Harm Reduction Journal](http://harmreductionjournal.biomedcentral.com/)","snPcode":"12954","submissionUrl":"https://submission.nature.com/new-submission/12954/3","title":"Harm Reduction Journal","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Hepatitis C virus, HIV coinfection, people who inject drugs, treatment outcomes, general practitioners, community health workers, peer educators, remote setting.","lastPublishedDoi":"10.21203/rs.3.rs-5238109/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5238109/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e People who inject drugs (PWID) are at a heightened risk of co-infection with HIV and hepatitis C virus (HCV), which adversely affects health outcomes. Uncontrolled HCV can lead to increased transmission rates among PWID, highlighting the urgent need for improved access to treatment as a public health priority. Despite the availability of effective HCV treatments, access remains limited, particularly in remote areas, where stigma further complicates care. Implementing integrated and differentiated HCV care in these regions could help address this gap. This study evaluated a novel care model in remote settings, where general practitioners delivered integrated HCV-HIV care, telemonitored by specialists and supported by community health workers and peer educators. We evaluated treatment outcomes and associated predictors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eWe used routine program data from the HCV treatment register to assess treatment completion rates and sustained virologic response (SVR) among PWID. SVR was defined as an undetectable HCV viral load 12 weeks after treatment completion. Patients who achieved SVR were invited for retesting at one year to calculate the one-year SVR rate. Logistic regression analyses were performed to identify predictors of both SVR and one-year SVR.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eAmong 314 HIV-HCV co-infected PWID who initiated HCV treatment, 93.0% completed it, 96.2% had 12-week HCV-RNA results, and 77.9% achieved SVR. After one year, 67.7% (126 of 186) maintained SVR. Methadone maintenance therapy (aOR: 2.22; 95% CI: 1.09-4.55) and advanced liver disease—fibrosis (aOR: 2.33; 95% CI: 1.05-5.16) and cirrhosis (aOR: 3.21; 95% CI: 1.13-9.10)—were significantly linked to one-year SVR (p ≤ 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eA novel care model involving general practitioners, specialist telemonitoring, and support from community actors has shown effectiveness for most HIV-HCV co-infected PWIDs. However, further qualitative research is needed to enhance SVR rates and better understand the reasons behind incomplete follow-up.\u003c/p\u003e","manuscriptTitle":"A novel model of care; Telemedicine and peer support for HCV care among HIV infected people who inject drugs in remote Myanmar: A retrospective study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-23 07:45:31","doi":"10.21203/rs.3.rs-5238109/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-09T00:53:04+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-27T19:48:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"226097887501149399227756186757483913389","date":"2025-08-07T12:25:41+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-03-09T10:32:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"131147806508503168991715996266481667328","date":"2025-02-23T23:21:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"190116436821158063087848469702110697530","date":"2025-02-20T01:20:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"165785295683268718415250058332780485055","date":"2024-10-22T07:50:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"126597422275137091680611702698128907165","date":"2024-10-22T01:17:36+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-10-19T22:07:47+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-10-11T12:12:35+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-10-11T12:11:48+00:00","index":"","fulltext":""},{"type":"submitted","content":"Harm Reduction Journal","date":"2024-10-10T09:02:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"harm-reduction-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"harj","sideBox":"Learn more about [Harm Reduction Journal](http://harmreductionjournal.biomedcentral.com/)","snPcode":"12954","submissionUrl":"https://submission.nature.com/new-submission/12954/3","title":"Harm Reduction Journal","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"026a7bec-51cd-41c7-875a-8ee1cd50cb33","owner":[],"postedDate":"October 23rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-27T16:13:42+00:00","versionOfRecord":{"articleIdentity":"rs-5238109","link":"https://doi.org/10.1186/s12954-026-01463-5","journal":{"identity":"harm-reduction-journal","isVorOnly":false,"title":"Harm Reduction Journal"},"publishedOn":"2026-04-24 15:58:18","publishedOnDateReadable":"April 24th, 2026"},"versionCreatedAt":"2024-10-23 07:45:31","video":"","vorDoi":"10.1186/s12954-026-01463-5","vorDoiUrl":"https://doi.org/10.1186/s12954-026-01463-5","workflowStages":[]},"version":"v1","identity":"rs-5238109","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5238109","identity":"rs-5238109","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}