The impact of universal access to direct-acting antiviral therapy on the hepatitis C cascade of care among individuals attending primary and community health services

Abstract

Background Hepatitis C elimination will require widespread access to treatment and responses at the health-service level to increase testing among populations at risk. We explored changes in hepatitis C testing and the cascade of care before and after the introduction of direct-acting antiviral treatments in Victoria, Australia. Methods De-identified clinical data were retrospectively extracted from eighteen primary care clinics providing services targeted towards people who inject drugs. We explored hepatitis C testing within three-year periods immediately prior to (pre-DAA period) and following (post-DAA period) universal access to DAA treatments on 1 st March 2016. Among ever RNA-positive individuals, we constructed two care cascades at the end of the pre-DAA and post-DAA periods.

The impact of point‐of‐care hepatitis C testing in needle and syringe exchange programs on linkage to care and treatment uptake among people who inject drugs: An Australian pilot study

“…Despite this, loss to follow‐up was only 34% and treatment uptake was 49% despite most people in this cohort having significant risks for disengagement from care. This rate of treatment uptake is comparable to the 45% treatment uptake reported in sentinel surveillance reports describing the cascade of care and treatment uptake among clients of community centres focussed on the care needs of PWID 26 and estimated 50% treatment uptake among the whole Australian population who are living with hepatitis C 10 . In the ETHOS Engage cohort study, 63% of 1443 people who were attending drug treatment clinics or NSPs across New South Wales self‐reported lifetime hepatitis C treatment uptake 13 .…”

“…10 Among people who inject drugs, in a study by Traeger and colleagues describing the hepatitis C cascade of care within a sentinel surveillance network of primary health services with a high proportion of people who inject drugs, 45% of people who were HCV RNA-positive were prescribed DAAs. 26 Within the ETHOS Engage cohort study of people who inject drugs, 13 66% of HCV RNA-positive participants were treated, though this was within a research trial environment. Importantly, while almost all participants had a history of hepatitis C testing, the majority (84%) had never previously engaged in hepatitis C care.…”

Real-world monitoring progress towards the elimination of hepatitis C virus in Australia using sentinel surveillance of primary care clinics; an ecological study of hepatitis C virus antibody tests from 2009 to 2019

“…The National Testing Policy further encourages reflex HCV RNA testing, therefore increases in HCV antibody testing are likely to result in increased diagnosis where reflex testing is undertaken [ 6 ]. Despite the benefits of people accessing HCV care in Australian primary settings, [ 14 , 15 ] HCV treatment by primary care providers has not increased, [ 16 ] and significant gaps remain in linking those diagnosed in primary care to timely treatment initiation [ 17 ]. While we did not monitor trends in HCV treatment in these clinics, our analysis suggests there are ongoing and significant opportunities for HCV diagnoses, and therefore treatment in primary care clinics, especially to individuals accessing OAT.…”

How can general practitioners support people who inject drugs to engage with direct-acting antiviral treatment for hepatitis C? A qualitative study

“…GPs can play a significant part in increasing uptake and completion of DAA treatment among PWID and contribute to Australia achieving HCV elimination goals. 5,16,[20][21][22] This study highlights practical ways GPs can support PWID to access and complete DAA treatment.…”