Hepatitis C Treatment Uptake and Completion Among Young Adults Who Inject Drugs: Identifying Gaps To Inform Response

Author: Meghan D Morris, Ali Mirzazadeh, Jennifer Evans, Alya Briceno, Kimberly Page, Judith A Hahn

Theme: Epidemiology & Public Health Research Year: 2017

Background: To achieve the U.S. goal of eliminating 90% of new HCV infections by 2030, access to and uptake of hepatitis C virus (HCV) treatment is necessary among people who inject drugs (PWID). This is especially so among young adult (age <30) PWID who are at high risk of transmitting HCV, even in San Francisco, a city with relatively high levels of prevention services, but HCV incidence of 25% per year. This study describes the cumulative retention from HCV RNA detection to achievement of sustained virologic response (SVR) after uptake of HCV treatment among young adult PWID. Methods: This analysis was conducted in the UFO study, a prospective cohort study of actively injecting young adult (age <30) PWID to detect acute HCV. Among those who became HCV infected (via HCV antibody and RNA testing), we calculated the proportion referred to HCV treatment within 6 months of RNA detection, clinically assessed, initiated and completed treatment, and achieved SVR following treatment with direct-active antiviral (DAA) therapy. Results: Of the 37 HCV RNA positive persons with incident HCV identified between December 2011 and February 2017, the majority (73%) were male, with median age 23 (IQR: 21-25); 73% injected heroin most often in past month; 95% were recently homeless; and median number of injecting partners was 10 (IQR: 3-15). Seven (19%) cleared infection prior to treatment. Seventeen (57%; 95% CI: 37-75%) were referred to HCV treatment, all 4 (13%; 95% CI: 4-31%) who initiated and completed HCV treatment, and reached SVR. Conclusion: HCV treatment for actively injecting young adult PWID has only recently become available, and currently, treatment uptake in this population is low. Our pilot study underlines the need for increased referral to HCV treatment and treatment uptake to make progress towards the goal of HCV elimination in San Francisco.

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