Uptake and predictors of direct-acting antiviral treatment for hepatitis C among people receiving opioid agonist therapy in Sweden and Norway: a drug utilization study from 2014 to 2017

Abstract

Background: Treatment with direct-acting antiviral agents (DAAs) offers an opportunity to eliminate hepatitis C virus (HCV) endemic among people who inject drugs (PWID) and people enrolled in opioid agonist therapy (OAT) programs. The objective of this study was to estimate and to compare HCV treatment uptake after the introduction of DAAs among patients receiving OAT in Sweden and Norway. We also aimed to evaluate predictors of DAAs treatment among OAT patients in both countries. Methods: This observational study was conducted with data from The Swedish Prescribed Drug Register and The Norwegian Prescription Database. We studied dispensed medications to calculate HCV treatment among OAT patients from 2014 to 2017 in Sweden and Norway. HCV prevalence was estimated from primary and secondary sources. Dispensations of medicines from different therapeutic areas, which served as proxy for co-morbidities in 2017, were conditionally adjusted for age, gender, and OAT medications. Logistic regression was used to evaluate these parameters. Results: In total 3529 individuals were identified with dispensed OAT in the Swedish cohort and 7739 individuals in the Norwegian cohort. HCV treatment was utilized by 407 persons in Sweden and 920 in Norway during the study period. Annual HCV and DAA treatment uptake increased in both countries. The estimated cumulative HCV treatment uptake at the end of 2017 was 31% in Norway and 28% in Sweden. DAA treatment was associated with increased age (aOR 1.8; 95% CI 1.0-3.2) and the dispensation of drugs used for diabetes (aOR 3.2; 95% CI 1.8-5.7) in Sweden. In Norway, lipid modifying agents and antibacterials were associated with decreased odds (aOR 0.4; 95%CI 0.2-0.9, aOR 0.8; 95%CI 0.6-1.0).

Integrated treatment of hepatitis C virus infection among people who inject drugs: A multicenter randomized controlled trial (INTRO-HCV)

“…This group of patients has a significant disease burden and limited ability to utilize standard healthcare. In the area surrounding the included clinics, around half of PWID had chronic HCV at the start of follow-up [ 25 ].…”

Real‐world hepatitis C prevalence and treatment uptake at opioid agonist therapy clinics in Ontario, Canada

“…Our analysis suggests that people ≥41 years old with chronic HCV-both Known Ab+ and New Ab+-are significantly more likely to complete treatment (particularly New Ab+ who are males ≥41 years old) compared to their younger counterparts, similar to previous studies that hypothesize that older OAT patients' lives and drug use are more stable combined with the realization that the possibility of serious liver disease from HCV increases with age. 38,51 It also suggests that OAT clinics are suitable environments to reengage Known Ab+ into care, regardless of age, further suggesting the importance of providing onsite DAA at these clinics.…”

Real-world hepatitis C treatment outcomes and reinfections among people who inject drugs at a needle and syringe program in Stockholm, Sweden

“…Previous data, before the DAA era, showed that the overall lifetime uptake of HCV treatment among PWID on OAT was between 1 and 6% [ 34 – 36 ]. However, an observational study with data from the Swedish Prescribed Drug Registers noted an estimated cumulative DAA treatment uptake of 28% among OAT participants between 2014 and 2017 [ 37 ].…”