Theme: Epidemiology & Public Health Research Year: 2018
Background:
Integrated treatment and harm reduction services provide a unique opportunity to facilitate
direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV)-infected people who inject
drugs (PWID). We examine the cascade of care at a community-based HCV-treatment
facility for PWID.
Methods:
The Queensland Injectors’ Health Network (QuIHN) is a community-based agency providing
harm reduction and treatment services, using a case manager support framework for their
HCV Treatment and Management Program (TMP). Administrative data from QuIHN’s
TMP were analysed for participants who enrolled from program commencement in early
2015 to December 2017.
Results:
By the end 2017, 476 participants with a confirmed HCV infection had enrolled in QuIHN’s
TMP and 341 (71.6%) had commenced treatment. Participants who had not commenced
treatment were more likely to be younger (ref 18-34years; 35-49 years OR = 0.55, p <0.05,
50+ years OR = 0.34, p<0.01) and less likely to feel safe and stable in their housing (OR =
0.43, p<0.05). Overall, 207 participants have a confirmed sustained virologic response at
12-weeks post-treatment (SVR12) (43.4% of whole sample, 64.7% of those eligible for
SVR12 testing). Of those who have been tested, five did not achieve SVR (97.6% achieved
SVR). Of the 107 who had not returned for SVR12 testing, 43 (40%) had attended an end of
treatment blood test and returned a negative PCR test.
Conclusion:
Despite increased treatment uptake since DAAs were introduced in Australia, a lack of safe
and stable housing seems to be a barrier to starting treatment for many PWID. Point of care
testing including same-day scripting for treatment could improve initial retention. Further,
while treatment efficacy is high for those attending SVR12 testing, a lack of attendance
makes it difficult to determine true efficacy. We are exploring whether clients are only
missing post-treatment testing or disengaging with services completely.
Disclosure of Interest Statement:
The QuIHN Treatment and Management Program (TMP) is funded by the Queensland
Government, Department of Health through the Communicable Diseases Unit (Project
ID: 70251).
Despite an increase in treatment uptake since the introduction of DAAs in Australia, a lack of
safe and stable housing seems to be a barrier to starting treatment for a proportion of PWID
who seek out treatment. While point of care testing may provide a solution in the future if
participants can be tested and scripted for treatment on the same day, in the mean time ….