Theme: Epidemiology & Public Health Research Year: 2024
Background: In British Columbia and most provinces in Canada, pre-treatment fibrosis levels are used to monitor for liver damage prior to initiating treatment for hepatitis C (HCV) and required to access provincial reimbursement for treatment. This requirement may require extra blood work and additional visits that can delay or stall treatment initiation. The introduction of highly effective and safer DAA treatments has changed standard of care to encourage treatment as early as possible, even before significant liver damage or fibrosis has occurred. As a result, there is now a growing debate and research data from experienced healthcare professionals regarding the need to measure fibrosis levels before initiating HCV treatment, especially for individuals under the age of 35.
Method: A chart review was conducted, extracting client information, including age, year of treatment initiation, and pre-treatment fibrosis level for individuals accessing nurse-led HCV treatment through the Cool Aid Community Health Centre (CACHC) between November 2014 (beginning of DAA treatment at clinic) until end of December 2022. Reimbursement restrictions requiring high fibrosis level of F2 or above for treatment were lifted in 2018. This particular analysis examined longitudinal trends in pre-treatment fibrosis level among the cohort.
Result: A total of 760 participants were included in the chart review: mean age 50, 32% female, 13% co-infected with HIV, 68% drug use reported in last 6 months. In total, 97% completed treatment, 91% achieved sustained virological response (SVR), and 4% were reinfected. Fibrosis levels by APRI 49%) and Fibroscan (50%) found: F0-F1 (44%) F2 (30%), F3 (10%), F4 (16%) and Unknown (1%). Fibrosis levels at treatment have dropped considerably over the study period, especially for those 35 years of age or younger.
Conclusion: These findings demonstrate how local research can advocate for changes to policies to streamline the care cascade for those living with HCV.