Outpatient directly observed therapy for hepatitis C among people who use drugs: a systematic review and meta-analysis.

We conducted a meta-analysis of randomised studies that assessed the effectiveness of directly observed hepatitis C medication therapy delivered in outpatient clinics compared to treatment as usual.  We completed a systematic literature review up to the end of August 2017, including online databases, study abstracts and references of pertinent articles. We assessed the results of randomised studies using the Cochrane Collaboration risk of bias assessment tool, and observational studies using the ROBINS-I tool. From each study, we extracted the number of patients who did or did not attain sustained virological response (SVR). We utilised a DerSimonian and Laird random effects model for our meta-analysis. This study is registered with PROSPERO (CRD42014012957).  We included six studies with 407 patients in our systematic review; four of those studies (215 patients) used randomisation and were included in our meta-analysis. Overall effect estimates showed that compared to treatment as usual, directly observed therapy demonstrated significantly higher odds of SVR attainment (odds ratio 2.01, 95% confidence interval 1.13-3.59).  Among people who use drugs, directly observed therapy may lead to higher odds of attaining SVR. Further research on the best ways to use directly observed therapy to administer HCV therapy to people who use drugs is warranted.