Improvements in substance use and social determinants of health associated with hepatitis C treatment initiation and sustained virologic response in opioid treatment programs

Background: Although opioid use disorder (OUD) and hepatitis C virus (HCV) frequently co-occur, few studies have evaluated substance use and social determinants of health (SDOH) that predict HCV treatment initiation and sustained virologic response (SVR). Methods: We used administrative and clinical trial outcome data from HCV-infected methadone-treated participants ( n=522 ) to evaluate changes in substance use and SDOH associated with HCV treatment initiation and SVR. We performed random forest analysis for investigating factors that predict HCV treatment initiation and SVR. Additionally, we applied the factor analysis for mixed data method for dimensionality reduction and used a clustering method to divide participants into subgroups to assess individual and regional-level differences. Results: HCV treatment approach (i.e., through telemedicine or referral), methadone duration, age, and degree of substance use correctly identified HCV treatment initiation in 75% and SVR in 94% of participants, respectively. Grouping participants based upon SDOH (first principal dimension), substance use (second dimension), and medical comorbidities, mental health disorders and demographics (third dimension) identified individual and regional level differences. Conclusions: We identified changes in substance use and SDOH associated with HCV treatment initiation and SVR. Individual and regional-level subgroup differences could guide intervention implementation. HCV treatment initiation and SVR lead to improvements, not only in liver and infectious diseases outcomes, but in social and substance use factors.