Test uptake and hepatitis C prevalence in 5483 Danish people in drug use treatment from 1996 to 2015: a registry‐based cohort study

Abstract

Background and aims The aims of this study were, in people in treatment for drug use in Funen, Denmark, to: (1) assess prevalence of hepatitis C virus (HCV) test uptake and prevalence of HCV; (2) identify predictors of test update and HCV infection; and (3) characterize changes between 1996 and 2015 in test uptake, HCV prevalence and drug use.Design Cohort study linking the Danish National Registry on Drug Users in Treatment to the regional hepatitis test registry and the Danish Death Certificate Registry, thus combining longitudinal data on drug use with data on HCV testing and results. Setting and participants People recorded as having received treatment for drug use between 1996 and 2015 (n = 5483) in Funen, Denmark. In the cohort, 24.8% were female, median age 23 years [interquartile range (IQR) = 20-32] at entry and 50% had self-reported injecting or had received opiate substitution therapy (OST). MeasurementsThe main outcomes were the test for HCV ever and latest HCV-RNA being positive. The main predictors were for test and infection investigated; ever receiving OST, self-reported injecting, age at entry and connection to treatment centre offering outreach hepatitis care. Findings HCV test uptake was 52% and prevalence of current HCV-RNA+ was 21% in people alive at the end of follow-up. Positive predictors of having undergone HCV testing were: receiving OST [odds ratio (OR) = 3.7; 95% confidence interval (CI) = 3.2-4.5], self-reported injecting (OR = 2.3; 95% CI = 2.0-2.7), female gender (OR = 1.7; 95% CI = 1.4-1.9) and having been connected to centres with outreach hepatitis care (OR = 1.4; 95% CI = 1.2-1.7). In people alive, HCV-RNA+ prevalence was 31% if ever on OST or self-reported injecting. Among HCV-infected people, 69% were in drug use treatment at end of follow-up. For participants entering the cohort after 2010, only 5% reported opiates as main drug of use and 17% had experience of injecting. Conclusion Among Danish people in treatment for drug use from 1996 to 2015, receiving opiate substitution therapy had the largest associating to being tested for hepatitis C virus. As opiate use is declining, adapting test strategies will be necessary.

Hepatitis C prevalence in Denmark in 2016—An updated estimate using multiple national registers

“…Another force driving the reduction in CHC prevalence in Denmark was a low CHC prevalence in young people who use drugs [23]. Moreover, several studies suggest that fewer young people inject drugs in later years [12,19,23]. The very low CHC prevalence among those younger than 40 years also suggests a low incidence of new infections.…”

The Copenhagen test and treat hepatitis C in a mobile clinic study: a protocol for an intervention study to enhance the HCV cascade of care for people who inject drugs (T’N’T HepC)

“…14 Within Danish contexts, a regional study on PWID connected to addiction services (1996-2015) found a prevalence of persons with positive anti-HCV antibodies (Anti-HCV Ab+) of 64% and 33% for HCV RNA+ (ie, chronically infected). 15 Before the DAA era in Denmark, approximately 20 000 persons had chronic HCV, an estimated 500 persons were newly infected each year and, of these, 300 would develop chronic HCV. 16 In 2015, the estimated prevalence of people with HCV and active infection (ie, viraemic) was 0.3% 17 and at the end of 2016 the population living with diagnosed chronic HCV was 7581 people, of which the estimated undiagnosed fraction was 24% and so the total diagnosed and undiagnosed number was estimated to be 9975, corresponding to 0.21% of the adult population.…”

A multi-level intervention to eliminate hepatitis C from the Region of Southern Denmark: the C-Free-South project

“…1 ). Additional data sources were identified to estimate the sizes of populations at risk for undiagnosed or untreated infections [ 34 , 43 , 44 ]. On the basis of these data, a multi-level intervention program consisting of five interventions has been designed with the goal of achieving elimination.…”

“…Testing and treatment for hepatitis C in the RSD was initiated in two drug treatment centers (DTCs) and one prison on Funen in 1996 [ 45 – 47 ]. A registry-based cohort study with people in drug use treatment based on 1996–2015 data found a prevalence of 62% HCV exposure and 33% HCV infection in people who reported ever injecting and who were alive at the end of 2014 [ 43 ]. The HCV test uptake in persons connected to six DTCs in the RSD was 52%, while the HCV test uptake in the remaining nine DTCs is unknown but assumed to be much lower [ 43 ].…”

“…A registry-based cohort study with people in drug use treatment based on 1996–2015 data found a prevalence of 62% HCV exposure and 33% HCV infection in people who reported ever injecting and who were alive at the end of 2014 [ 43 ]. The HCV test uptake in persons connected to six DTCs in the RSD was 52%, while the HCV test uptake in the remaining nine DTCs is unknown but assumed to be much lower [ 43 ]. According to national guidelines, yearly testing for hepatitis B and C is recommended for clients attending DTCs [ 48 , 49 ].…”