Hepatitis C cascade of care in individuals tested in drug services after the introduction of direct-acting antivirals, 2016-2022.

Author: Annabel Powell

Theme: Epidemiology & Public Health Research Year: 2023


Persons who inject drugs (PWID) are at increased risk, and make up most cases, of Hepatitis C infection in England. We aim to present the cascade of care (CoC) amongst this group after the introduction of direct acting antivirals (DAAs).


Data were extracted for individuals testing anti-HCV positive in drugs services in Sentinel Surveillance of Blood Borne Virus Testing (SSBBV) and linked to HCV treatment databases. We describe the CoC as an HCV RNA test, linkage into care, and treatment outcomes. Multivariable models assessed progression through the CoC by age, sex, region and year of test.


Between 01/01/2016 and 30/06/2022, 47,614 individuals were anti-HCV positive, 89.3% (42,512/47,614) had an HCV RNA test, 39.0% (16,573/42,512) were RNA positive. 45.3% (7,505/16,573) of RNA positive individuals had identifiers, 80.9% (6,073/7,505) were linked to a treatment record, 81.4% (4,944/6,073) began treatment, 75.3% (3,723/4,944) had an outcome recorded, 67.6% (2,516/3,723) achieved SVR and 24.5% (910/3,723) were lost to follow-up. There was no difference in likelihood of an RNA test between sexes, however females were less likely to continue through the CoC compared to males. During the 5.5-year period, the odds of an RNA test increased (OR:1.35, 95%CI 1.33-1.37), whereas having an outcome recorded or SVR decreased (OR:0.96, 95%CI 0.95-0.98).


Our findings provide HCV CoC estimates for individuals attending drug services after the introduction of DAAs and are important to measure progress towards elimination of HCV as a public health threat. We show increases across the CoC following scale-up of case finding and (re)engagement into treatment compared with pre-DAA estimates, although do not include PWID not tested in drugs services who may be at highest risk of infection. Continued improvements in data quality, linkage to care, and retention across the CoC are needed, especially for females, and those lost to follow-up.

Download abstract Download poster