Universal access to DAA therapy paves the way for HCV control and elimination among people living with HIV in Australia

Martinello, Marianne; Bartlett, S; Dore, Greg; Bopage, Rohan; Finlayson, Robert; Baker, Danial E.; Bloch, Mark; Doyle, Joseph S; Shaw, David; Hajkowicz, Krispin; Read, Phillip; Filep, Ecaterina; Lin, Lei; Yee, Jasmine; Applegate, Tanya; Hellard, Margaret; Matthews, Gail V.

doi:10.1016/s0168-8278(18)30843-2

Cited by 5 publications

(4 citation statements)

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“…[34][35][36][37] As providers are only one link in the care cascade, coordinated approaches are needed to prioritize and allocate resources for better outcomes. 31,32 This has led many countries to form national plans such as those in Spain, 38 Netherlands, 39,40 France, 41 European Union, 42 Australia, 43,44 and United States. 45 In many of these countries, recent efforts for universal DAA access has improved treatment uptake and HCV incidence/prevalence, even in co-infected populations.…”

Section: Discussionmentioning

confidence: 99%

“…45 In many of these countries, recent efforts for universal DAA access has improved treatment uptake and HCV incidence/prevalence, even in co-infected populations. 40,41,43 However, there often is a significant upfront cost while upscaling, which demonstrates the continued need for coordinated approaches to patients and resource allocation. 46 In 2016, the United States Veterans Administration (VA) prioritized funding for testing and treatment of all HCV-infected patients as part of a coordinated plan that included methods to address screening, prescribing capacity, linkage to care, treatment financing, and barriers to care (e.g., homelessness, substance use, mental health).…”

Section: Discussionmentioning

confidence: 99%

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Hepatitis C care cascade in HIV patients at an urban clinic in the early direct-acting antiviral era

Non

Amornsawadwattana

et al. 2019

Int J STD AIDS

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Guidelines advocate universal, prompt treatment of hepatitis C (HCV) infection in HIV/HCV co-infected patients, but barriers to uptake of HCV direct-acting antivirals (DAAs) remain unclear in this population. This retrospective study investigated the care cascade from HCV diagnosis to sustained virologic response (SVR) at an urban infectious disease clinic in Saint Louis, Missouri during the first 18 months of interferon-free DAA availability in the United States. Of 1949 HIV patients seen in clinic, 91.9% were screened for HCV and 5.4% (n = 106) had chronic HCV infection with follow-up. Of these 106 co-infected patients, 100 underwent fibrosis testing, 55 were offered DAAs, 38 completed treatment, and 37 achieved SVR. Delayed DAA treatment was associated with no insurance, substance abuse, poor HIV control, and younger age. Providers delayed DAA treatment most commonly for substance abuse, psychiatric disease, and uncontrolled HIV. Mean time to insurance decision from initial prescription was 20.9 ± 29.6 days and mean time to final decision was 29.9 ± 40.1 days. DAAs are highly successful in co-infected patients in this early period but insurance delays and misconceptions from the interferon era can ultimately limit uptake. Addressing these factors in a comprehensive treatment model may bridge disparities and improve real-world SVRs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Hepatitis C care cascade in HIV patients at an urban clinic in the early direct-acting antiviral era

Non

Amornsawadwattana

et al. 2019

Int J STD AIDS

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“…The lack of data also weakens global efforts to address socioeconomic health disparities. Given the limited data on HCV reinfection rates in PWID in resource-limited settings, policy makers should commit to using comprehensive programs that implement a broad range of public health strategies supported by most current modeling studies, including widespread testing, faster linkage to care, treatment for all, and increased access to harm reduction interventions [ 32 , 33 , 34 , 35 , 36 ]. These interventions should be combined with efforts to specifically engage PWID in resource-limited countries and further our understanding of the HCV epidemic.…”

Section: Discussionmentioning

confidence: 99%

Hepatitis C Reinfection in People Who Inject Drugs in Resource-Limited Countries: A Systematic Review and Analysis

Muller

Vlahov

Akiyama

et al. 2020

IJERPH

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Hepatitis C (HCV) is a global pandemic. The World Health Organization has developed a strategic plan for HCV elimination that focuses on low- and middle-income countries (LMICs) and high-risk populations, including people who inject drugs (PWID). While direct-acting antiviral (DAA) therapies are highly effective at eliminating HCV infections and have few side effects, medical professionals and policymakers remain concerned about the risk of reinfection among PWID. This study is a systematic review of research measuring the rate of HCV reinfection among PWID in LMICs and identifies additional areas for further research. A systematic search strategy was used to identify studies documenting HCV reinfection after sustained virologic response in PWID in LMICs. We refined results to include studies where at least 50% of participants had DAA treatment for primary HCV infection. Pooled reinfection rate was calculated across all studies. Seven studies met eligibility criteria. Most studies were conducted in six upper middle-income countries (Mexico, Romania, Russia, Taiwan, Georgi, and Brazil) and one lower middle-income country (Bangladesh) with a total of 7665 participants. No study included information from PWID in low-income countries. Sample sizes ranged from 200 to 3004 individuals, with demographic data missing for most participants. Four studies used deep gene sequencing, and reflex genotyping procedures to differentiate reinfection (infection by a different HCV genotype/subtype) from virologic relapse (infection by the same strain). The follow-up time of people cured from primary chronic HCV infection ranged from 12 weeks to 6.6 years. The pooled reinfection rate of all seven studies was 2.8 (range: 0.02 to 10.5) cases per 100 person-years (PY). In the five studies that differentiated relapse from reinfection, the incidence of reinfection was 1.0 per 100 PY. To date, research on reinfection rates among PWID in LMICs remains limited. Research focused on PWID in low-income countries is particularly needed to inform clinical decision making and evidence-based programs. While rates of reinfection among PWID who complete DAA treatment in upper and lower middle-income countries were similar or lower than rates observed in PWID in high-income countries, the rates were highly variable and factors may influence the accuracy of these measurements. This systematic review identifies several areas for continued research. Policies concerning access to HCV testing and treatment should be comprehensive and not place restrictions on PWID in these settings.

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“…Direct-acting antiviral therapies (DAAs) for HCV have proven to have a treatment efficacy of >95% cure [ 3 , 4 , 5 ] and excellent tolerability [ 3 , 6 ], and they have dramatically increased treatment access and completion compared to interferon-based therapies [ 3 ]. These DAA medications have permitted broader access and prescriber bases, with outcomes comparable between primary care and tertiary settings [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Hepatitis C (HCV) Reinfection and Risk Factors among Clients of a Low-Threshold Primary Healthcare Service for People Who Inject Drugs in Sydney, Australia

Read,

Tang,

Silins

et al. 2024

Viruses

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Hepatitis C (HCV) reinfection studies have not focused on primary healthcare services in Australia, where priority populations including people who inject drugs (PWID) typically engage in healthcare. We aimed to describe the incidence of HCV reinfection and associated risk factors in a cohort of people most at risk of reinfection in a real-world community setting. We conducted a secondary analysis of routinely collected HCV testing and treatment data from treatment episodes initiated with direct-acting antiviral (DAA) therapy between October 2015 and June 2021. The overall proportion of clients (N = 413) reinfected was 9% (N = 37), and the overall incidence rate of HCV reinfection was 9.5/100PY (95% CI: 6.3–14.3). Reinfection incidence rates varied by sub-group and were highest for Aboriginal and/or Torres Strait Islander people (20.4/100PY; 95% CI: 12.1–34.4). Among PWID (N= 321), only Aboriginality was significantly associated with reinfection (AOR: 2.73, 95% CI: 1.33–5.60, p = 0.006). High rates of HCV reinfection in populations with multiple vulnerabilities and continued drug use, especially among Aboriginal and Torres Strait Islander people, highlight the need for ongoing regular HCV testing and retreatment in order to achieve HCV elimination. A priority is resourcing testing and treatment for Aboriginal and/or Torres Strait Islander people. Our findings support the need for novel and holistic healthcare strategies for PWID and the upscaling of Indigenous cultural approaches and interventions.

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Universal access to DAA therapy paves the way for HCV control and elimination among people living with HIV in Australia

Cited by 5 publications

References 0 publications

Hepatitis C care cascade in HIV patients at an urban clinic in the early direct-acting antiviral era

Hepatitis C care cascade in HIV patients at an urban clinic in the early direct-acting antiviral era

Hepatitis C Reinfection in People Who Inject Drugs in Resource-Limited Countries: A Systematic Review and Analysis

Hepatitis C (HCV) Reinfection and Risk Factors among Clients of a Low-Threshold Primary Healthcare Service for People Who Inject Drugs in Sydney, Australia

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