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Early Adherence Predicts SVR in ACTG MINMON study
Perspectives on Adherence From the ACTG 5360 MINMON Trial: A Minimum Monitoring Approach With 12 Weeks of Sofosbuvir/Velpatasvir in Chronic Hepatitis C Treatment
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Download the PDF here
Download the PDF here
Jan 2023
• In MINMON, a low contact reduced monitoring approach to HCV treatment, self-reported week 4 optimal adherence was high even in those reporting substance use (Figure 3). The high rate of optimal adherence (> 87%) in all substance use categories challenges the utility of administrative barriers to treatment access based on substance use used in some jurisdictions
• In this analysis we showed that remotely captured self-reported early optimal adherence at week 4 was associated with SVR. Individuals reporting early optimal adherence had an SVR of 96.5% compared to 77.8% for those reporting early sub-optimal adherence
• These findings suggest patients might benefit from interventions focused on maximizing adherence during the first weeks of treatment.
• MINMON demonstrated that high levels of adherence and SVR could be achieved using a minimal monitoring design with only 2 in-person visits. Participants were asked for preferred mode of contact including the following: telephone, text message, email, and WhatsApp (a social media platform).
• Self-reported early optimal adherence by remote contact was high; 368/395 (93%) reported perfect adherence (taking 100% SOF/VEL at week 4 (Table 1 and Supplementary Tables). Early optimal adherence ranged from 84% (108 of 128) participants in the United States, 87% (13 of 15) in Uganda, 98% (127 of 130) in Brazil, 98% (108 of 110) in Thailand, to 100% (12 of 12) in South Africa. of 15) (87%).
• Within subgroups, the lowest reported early optimal adherence was among individuals <30 years (24 of 32) (75%), those with ongoing psychoactive medication use (52 of 60) (87%), and those who reported current injection drug use (13 of 15) (87%).
CONCLUSION: Treatment barriers continue to limit uptake of HCV treatment in both high income and LMIC. A minimal monitoring approach with only 2 in-person visits, reduced laboratory testing, and a week 4 adherence assessment had high treatment completion and SVR. The remotely obtained week 4 adherence was a strong predictor of SVR. Implementing the MINMON strategy may overcome many of the structural barriers impeding access to HCV treatment globally. Treatment programs should consider incorporating early remote adherence assessment and providing additional support for those reporting sub-optimal adherence. Younger individuals (<30 years), and individuals with current prescriptions of psycho-active drugs may benefit from additional adherence support.
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