Exposure to opioid substitution therapy following hepatitis C notification: Implications for provision of antiviral therapies in drug treatment settings

Author: Larney S, Grebely J, Degenhardt L, Amin J, Law M, Alavi M, Dore GJ

Theme: Epidemiology & Public Health Research Year: 2016

Larney S1
, Grebely J2
, Degenhardt L1
, Amin J2
, Law M2
, Alavi M2
, Dore GJ3
1National Drug and Alcohol Research Centre, UNSW Australia
2Kirby Institute, UNSW Australia
Background: Opioid substitution therapy (OST) clinics are being explored as
settings for scaling up treatment for hepatitis C virus (HCV) infection among people
who inject drugs. However, not all people who inject drugs use opioids, or if they do,
they may not be interested in OST. Furthermore, a large proportion of people with
HCV no longer injects drugs, nor needs OST. This study aimed to determine the
proportion of anti-HCV+ people with an OST episode of sufficient duration to
complete HCV treatment.
Methods: Retrospective data linkage study in New South Wales, Australia. Data for
anti-HCV notifications (1993-2012) were linked to OST (1985-2014) and mortality
(1993-2014) databases. We defined an OST episode of 16 weeks duration as the
minimum suitable for completion of a 12-week HCV treatment course (4 weeks OST
stabilisation + 12 weeks HCV treatment)
Results: Among 96,888 people with an HCV notification, 26% (n=25,592) sought
OST at some point following their HCV notification. The median duration of
completed OST episodes was 171 days (IQR: 28-640 days). Of this group, 90%
(23,019/25,592) had an OST episode of at least 16 weeks duration. This was 24% of
the total HCV cohort. In 2013 (the most recent year with complete data), 11,571
people with an HCV notification (12% of the HCV cohort; 45% of those with an OST
history) had 16 or more consecutive weeks of OST.
Conclusion: Over a one year period, 12% of this population-based cohort of people
with an anti-HCV notification had sufficient OST exposure to enable completion of 12
weeks of HCV treatment. Targeting HCV treatment to OST settings will make an
important contribution to increasing HCV treatment coverage, particularly among
people at risk of onward transmission.
Disclosure of Interest Statement: SL and LD have received an untied educational
grant from Indivior. LD has received an untied educational grant from Mundipharma.
JG is a consultant/adviser and/or has received grants from Abbvie, Bristol-Myers
Squibb, Gilead, Janssen and Merck. GJD is a consultant/adviser and/or has received
grants from Gilead, Abbvie, Merck, Bristol-Myers Squibb, Janssen, Roche, GSK and
Abbott Diagnostics.

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