INTRODUCTION: Integrating patient navigation (PN) interventions in hepatitis C virus (HCV) elimination efforts enhances HCV treatment cascade outcomes from screening to cure. Nonetheless, little is known about how the patient-navigator working alliance influences the effectiveness of PN interventions. This study among persons who inject drugs (PWID) living with HCV aimed to assess the association between patient-navigator working alliance and HCV treatment cascade outcomes. METHODS: This study utilized the Hepatitis C Real Options (HERO) study data for a subset of participants from the PN arm who responded to the patient-navigator working alliance survey at the end-of-treatment timepoint (N = 227). Working alliance was measured using the 16-item Brief Alliance Inventory (BAI). The average BAI overall and subscales ('bonds' and 'tasks/goals') scores were calculated. Outcomes included sustained virologic response (SVR), HCV treatment adherence, duration, completion and HCV reinfection. Linear and logistic regression models were used for continuous and binary outcomes, respectively. RESULTS: Stronger overall working alliance was associated with a higher likelihood of achieving SVR [aOR (95 % CI) = 6.31 (1.68, 23.77)
p = .007]. Similarly, the likelihood of SVR was higher for stronger 'bonds' [7.65 (1.79, 32.76)
p = .006] and 'tasks/goals' [4.50 (1.35, 15.02)
p = .014] working alliance. However, working alliance was not significantly associated with the other outcomes. DISCUSSION: A stronger patient-navigator working alliance is associated with achieving HCV cure but not treatment adherence or completion. More studies are needed to understand the factors that enhance patient-navigator working alliance so that future PN interventions may further incorporate those features to improve HCV outcomes among PWID.