Adherence to treatment

Adherence to treatment is important, and managing any condition or circumstance that may affect adherence to treatment is recommended before commencing DAA therapy for HCV. People with stable psychiatric conditions and/or stable injecting drug use are candidates for DAA treatment. So too, with appropriate support, are people experiencing homelessness. People with no cirrhosis may continue to drink alcohol at low-risk levels during treatment (no more than 10 standard drinks a week and no more than four standard drinks on any one day; the less a person drinks, the lower the risk of harm from alcohol [46]. Complete abstinence from alcohol is recommended for people with cirrhosis or with alcohol dependence. For people with high-risk alcohol use, management of alcohol dependence should be considered before DAA therapy.

The Australasian Hepatology Association (AHA) has developed the AHA consensus guidelines for the provision of adherence support to patients with hepatitis C on direct acting antivirals. [47] The guidelines consist of 24 consensus recommendations that promote a patient-centred approach, asserting that all patients are at risk of medication non-adherence. “Treatment readiness” is a pivotal concept that influences subsequent adherent behaviour. The AHA guidelines recommend supporting DAA adherence through implementing interventions focused on the patient, such as identifying memory triggers and hooks; and linguistic advice for health professionals, including using non-confrontational and non-judgemental language. See the AHA website for further information. [48]