Closing the Hepatitis C Treatment Gap: United States Strategies to Improve Retention in Care

Austin T. Jones; Christopher Briones; Torrence Tran; Lisa Moreno-Walton; Patricia J. Kissinger


J Viral Hepat. 2022;29(8):588-595. 

In This Article

Directly Observed Therapy

Directly observed therapy (DOT) is a system whereby patients receive medications under the supervision of a health care provider. DOT aims to increase the treatment compliance by upholding a regular dose schedule and visually confirming dose administration. DOT models have proven to be effective in the treatment of chronic infections requiring complex therapy, such as tuberculosis and HIV.[37,38]

An increasing number of studies demonstrate that DOT is also both efficacious and well-received by patients in the treatment of HCV.[37–40] HCV-infected, methadone-maintained patients who were treated in a pegylated-interferon DOT programme were three times more likely to achieve SVR than those who self-administered treatment.[41] With DAAs being easier to administer orally and having a lower side effect profile, it is conceivable that a DOT model may also prove effective in DAA therapy. The structure of DOT models may be customized to suit the capacity of individual facilities. The provider conducting the observation may include physicians, nurses, community health workers or other trained staff, making DOT a feasible intervention in the absence of high-level providers.[38,39,42] The setting is also flexible; DOT has demonstrated effectiveness in prisons, primary care clinics, hepatology clinics, drug treatment facilities and pharmacies as patients who initiate treatment achieve SVRs ranging from 55% to 65%, up to 94% to 98%.[39] A meta-analysis of four randomized controlled trials demonstated that compared to standard treatment, DOT led to two-fold higher odds of achieving SVR.[39]

Studies have also demonstrated that DOT models may be especially effective for treating HCV in vulnerable populations.[37,38] Patients who receive outpatient methadone therapy for opioid dependence have a convenient opportunity to treat their comorbid HCV infection with the addition of DOT to their methadone schedule. As an important driver of the spread of HCV, improving retention for PWID through interventions such as DOT is critical to reducing HCV incidence.[38,39]