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Although some payers may require abstinence from methamphetamine prior to starting treatment, any such requirement is not consistent with recommendations in the AASLD-IDSA HCV Guidance.[3] HCV Treatment Outcomes in Persons with Stimulant Use Although there are limited data specific to the impact of stimulant use on outcomes of DAA therapy, several large trials evaluating treatment outcomes among persons with opioid use disorder have included sizable proportions of persons with concurrent stimulant use.[10,22] For example, in the HERO study, which was a randomized trial of sofosbuvir-velpatasvir plus modified directly observed therapy versus sofosbuvir-velpatasvir plus patient navigation in 8 opioid treatment programs and 15 community health centers, 32% of individuals with available urine drug screen results at baseline had a test positive for methamphetamine, and 42% were positive for cocaine,[10] In this study, SVR12 rates in the per-protocol analysis mirrored those of persons without substance use or stimulant use, with greater than 90% of participants with or without substance use achieving an SVR12.[10] Similarly, in the SIMPLIFY study, an open-label, single-arm trial of sofosbuvir-velpatasvir for persons with recent injection drug use, 30% reported injection methamphetamine use, and 13% reported injection cocaine use in the past 30 days.[22] In this study, 94% of individuals achieved an SVR12.[22] Management Strategies Stimulant use is often more intermittent than opioid or alcohol use but can also be associated with periods of poor adherence to medical care

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