Theme: Epidemiology & Public Health Research Year: 2019
Background: There is emerging evidence that Hepatitis C (HCV) treatment engagement is associated
with change in drug behaviours and reduced drug related death rates amongst people who inject drugs
(PWID). The project aims to investigate whether HCV diagnosis and engagement in treatment services
reduces all-cause mortality and drug related death, and whether any effect is dependent on treatment
regimen and intensity of engagement with staff.
Methods: Case control studies comparing: PWID with active HCV infection (PCR Positive) to PWID HCV
infected but cured spontaneously (PCR Negative); PCR Positive patients who engaged with treatment
services to non-engagers; and patients who received interferon vs direct acting antiviral (DAA) based
Results: 386 cases and 386 controls were included in the study. No differences in risk of all-cause
mortality (aOR 1.18, 95% CI 0.80- 1.73, p = .40) or drug related death (aOR 1.19, 95% CI 0.71- 2.00, p =
.51) between PCR Negative controls and PCR Positive cases was detected.
The odds of all-cause mortality was 12.2 times higher in non-engaging persons compared to treatment
engaging cases (aOR 12.15, 95% CI 7.03- 20.99, p < 0.001). The odds of a drug related death was 5.5 times higher in non-engaging persons compared to treatment engaging cases (aOR 5.52, 95% CI 2.67- 11.44, p < 0.001). No differences in risk of all-cause mortality (aOR 1.45, 95% CI 0.70- 2.98, p = .37) or drug related death (aOR 2.06, 95% CI 0.80- 5.23, p = .13) between interferon treated cases and DAA treated controls was detected. Conclusion: HCV treatment engagement is significantly protective against all-cause mortality and drug related death. This engagement effect is independent of treatment regimen, with the introduction of DAA therapies not increasing the risk of drug related death, suggesting intensity of engagement with staff is not an important factor. Disclosure of Interest: none