Hepatitis C virus testing, liver disease assessment and treatment uptake among people who inject drugs pre‐ and post‐universal access to direct‐acting antiviral treatment in Australia: The LiveRLife study

Abstract

Gaps in hepatitis C virus (HCV) testing, diagnosis, liver disease assessment and treatment uptake among people who inject drugs (PWID) persist. We aimed to describe the cascade of HCV care among PWID in Australia, prior to and following unrestricted access to direct‐acting antiviral (DAA) treatment. Participants enrolled in an observational cohort study between 2014 and 2018 provided fingerstick whole‐blood samples for dried blood spot, Xpert HCV Viral Load and venepuncture samples. Participants underwent transient elastography and clinical assessment by a nurse or general practitioner. Among 839 participants (mean age 43 years), 66% were male (n = 550), 64% (n = 537) injected drugs in the previous month, and 67% (n = 560) reported currently receiving opioid substitution therapy. Overall, 45% (n = 380) had detectable HCV RNA, of whom 23% (n = 86) received HCV treatment within 12 months of enrolment. HCV treatment uptake increased from 2% in the pre‐DAA era to 38% in the DAA era. Significant liver fibrosis (F2‐F4) was more common in participants with HCV infection (38%) than those without (19%). Age 50 years or older (aOR, 2.88; 95% CI, 1.18‐7.04) and attending a clinical follow‐up with nurse (aOR, 3.19; 95% CI, 1.61‐6.32) or physician (aOR, 11.83; 95% CI, 4.89‐28.59) were associated with HCV treatment uptake. Recent injection drug use and unstable housing were not associated with HCV treatment uptake. HCV treatment uptake among PWID has increased markedly in the DAA era. Evaluation of innovative and simplified models of care is required to further enhance treatment uptake.

Hepatitis C treatment uptake among people who inject drugs in the oral direct‐acting antiviral era

“…It was, however, encouraging that these proportions appeared to steadily increase among persons recruited between 2015 and 2018, with uptake nearly doubling in this 4‐year period. At the same time, this increase is lower than what has been observed in other settings like Australia, where rates of HCV treatment initiation increased 4‐ to 19‐fold in the first 2 years after DAA availability 29‐31 . Unlike in Australia, restrictions to HCV treatment based on abstinence requirements and liver fibrosis stage persist in many parts of the world and continue to negatively impact progress towards HCV elimination goals.…”

High dropout rate from aftercare program of antihepatitis C therapy for patients with history of injection drug use

“…Some of our findings are not consistent with those from other countries. In Australia and the Czech Republic, GT3 patients were predominant in PWID 13,14 . Previous studies in Japan have reported a high prevalence of GT2 in PWID 15,16 .…”

“…In Australia and the Czech Republic, GT3 patients were predominant in PWID. 13,14 Previous studies in Japan have reported a high prevalence of GT2 in PWID. 15,16 It was speculated that a community-specific HCV genotype had spread among PWID.…”

Model of Care for Microelimination of Hepatitis C Virus Infection among People Who Inject Drugs

“…HCV-infected PWID are often unaware of their infection, usually have difficulties in reaching public health services, and only one in ten of those diagnosed enter treatment [15]. Frequently, these kinds of patients are reluctant to accept medical help, and despite being aware that they are HCV-antibody positive, they do not undergo further evaluation or do not keep appointments [16,17]. Furthermore, they do not like to be referred to the hospital but prefer being treated in SerDs.…”