Linkage and retention in HCV care for HIV‐infected populations: early data from the DAA era

Abstract

IntroductionThere is currently no published data on the effectiveness of DAA treatment for elimination of HCV infection in HIV‐infected populations at a population level. However, a number of relevant studies and initiatives are emerging. This research aims to report cascade of care data for emerging HCV elimination initiatives and studies that are currently being evaluated in HIV/HCV co‐infected populations in the context of implementation science theory.Methods HCV elimination initiatives and studies in HIV co‐infected populations that are currently underway were identified. Context, intervention characteristics and cascade of care data were synthesized in the context of implementation science frameworks.ResultsSeven HCV elimination initiatives and studies were identified in HIV co‐infected populations, mainly operating in high‐income countries. Four were focused mainly on HCV elimination in HIV‐infected gay and bisexual men (GBM), and three included a combination of people who inject drugs (PWID), GBM and other HIV‐infected populations. None were evaluating treatment delivery in incarcerated populations. Overall, HCV RNA was detected in 4894 HIV‐infected participants (range within studies: 297 to 994): 48% of these initiated HCV treatment (range: 21% to 85%; within studies from a period where DAAs were broadly available the total is 57%, range: 36% to 74%). Among studies with treatment completion data, 96% of 1109 initiating treatment completed treatment (range: 94% to 99%). Among those who could be assessed for sustained virological response at 12 weeks (SVR12), 1631 of 1757 attained SVR12 (93%, range: 86% to 98%).ConclusionsEarly results from emerging research on HCV elimination in HIV‐infected populations suggest that HCV treatment uptake is higher than reported levels prior to DAA treatment availability, but approximately half of patients remain untreated. These results are among diagnosed populations and additional effort is required to increase diagnosis rates. Among those who have initiated treatment, completion and SVR rates are promising. More data are required in order to evaluate the effectiveness of these elimination programmes in the long term, assess which intervention components are effective, and whether they need to be tailored to particular population groups.

Sexually transmitted hepatitis C virus infections: current trends, and recent advances in understanding the spread in men who have sex with men

“…As treatment is costly and treatment uptake varies considerably across countries , effective behavioural interventions for MSM at risk of (re‐)infection are urgently needed. Qualitative research among HIV‐positive MSM with a cured HCV infection in the pre‐DAA era showed that the strongest motive to implement risk reduction strategies was the reward of avoiding HCV retreatment and its side effects , but this may have changed with the less burdensome DAA treatment. Also sexual risk norms within the MSM population, HCV stigma and non‐disclosure of HCV status forms barriers to safer sex, and drug use directly impedes the self‐efficacy of MSM to take risk reduction measures .…”

“…Recently, several studies evaluating the effect of behavioural and/or testing interventions with prompt treatment, on HCV incidence among HIV‐positive MSM have been initiated . “Real‐life” settings in the Netherlands and Switzerland showed that high uptake of DAA among HIV‐HCV co‐infected MSM in clinical care, in Switzerland combined with intensive HCV‐RNA screening and behavioural intervention, was followed by a reduction in HCV incidence .…”

Using the barriers and facilitators to linkage to HIV care to inform hepatitis C virus (HCV) linkage to care strategies for people released from prison: Findings from a systematic review

“…In order to design and evaluate interventions that seek to improve linkage to HCV care following release, an understanding of the barriers and facilitators to care should be explored. However, up until the recent DAA era, research to improve linkage to HCV care has been rarely undertaken for people released from prison . That said, because individuals incarcerated with HCV share similar sociodemographic and psychosocial characteristics as incarcerated HIV‐positive individuals, exploring barriers and facilitators to HIV care following release—care that now dates back several decades—may help advance HCV linkage to care strategies and related research .…”

The Rocky Road to viral hepatitis elimination: assuring access to antiviral therapy for ALL coinfected patients from low‐ to high‐income settings

“…HIV coinfected). Sacks‐Davis and colleagues have gathered data from numerous local and national initiatives working towards HCV elimination in HIV coinfected populations globally . They show that while treatment has increased substantially in the era of DAAs (mostly in high‐income countries) two‐thirds of people still have not accessed treatment.…”