Determinants of Treatment Adherence in Hepatitis C Patients in a Public Sector Setting in India

The National Viral Hepatitis Control Program has rapidly scaled hepatitis C virus (HCV) treatment. However, poor adherence and loss to follow-up have led to drug resistance, treatment failure, and increased healthcare costs. Given this background, the present study was conducted to evaluate the rate of loss to follow-up, assess adherence patterns to treatment, and identify factors associated with both of these among HCV patients. A prospective cohort study was conducted among 385 adult HCV patients at Government Medical College, Patiala, Punjab, India. Patients were enrolled from April 2023 to December 2023 and followed from treatment initiation to sustained viral response assessment. Adherence was measured via monthly pill counts and self-reporting. Factors influencing loss to follow-up were analyzed using the χ2 and Fisher's exact tests for qualitative variables, as well as Student's t-test and the Mann-Whitney U test for quantitative variables. Adherence patterns between follow-up visits were assessed using the Wilcoxon signed-rank test. Multivariate logistic regression analysis was used to identify predictors of ≥90% pill adherence. Loss to follow-up was reported in 21.0% of patients and was significantly associated with intravenous drug use (P = 0.03; odds ratio [OR] 2.04 [95% CI: 1.17-3.55]), decompensated cirrhosis (P <0.001; OR: 4.95 [95% CI: 2.03-12.05]), taking sofosbuvir and velpatasvir (P = 0.012; OR: 1.99 [95% CI: 1.16-3.40]), and a treatment duration of 24 weeks (P = 0.001; OR: 3.90 [95% CI: 1.71-8.87]). Adherence improved notably between the first and second follow-ups (P <0.001), as well as between the third and fourth follow-ups (P = 0.003). Among the 304 patients who completed treatment, only 49% adhered to ≥90% of the pills. Younger age (adjusted OR [aOR]: 0.98 [CI: 0.96-0.99]), employment in the unorganized sector (aOR: 0.22 [CI: 0.07-0.63]), and cirrhosis (aOR: 1.98 [CI: 1.06-3.70]) emerged as significant predictors of greater adherence among patients who completed treatment. Patients with ≥90% adherence had higher treatment success rates (crude OR: 4.47 [CI: 1.77-11.28]). Attrition remained a major barrier to HCV care, and it was associated with intravenous drug use, decompensated cirrhosis, the sofosbuvir/velpatasvir regimen, and longer treatment duration. Adherence improved over time in follow-up, and good adherence was associated with good treatment outcomes.