|
BACKGROUND
Direct acting antiviral hepatitis C virus (HCV) treatment has enabled people who inject drugs (PWID) to be successfully treated. However, there is a need to identify groups of PWID who are currently living with active HCV and who are not treated. We aimed to examine HCV RNA prevalence and treatment among PWID from November 2022 to June 2024.
METHODS
Data were from HEPCO, a cohort study of PWID in Montreal. Prevalent HCV was defined as a viral load ≥20IU/ml at each person’s first visit during the analysis period. Poisson regression with robust variance was used to examine factors associated with prevalent infection compared to people who were HCV antibody positive/HCV RNA negative.
Among people with a HCV RNA positive test, treatment uptake was examined by self-report complemented with laboratory results with differences examined using Fisher’s exact test.
RESULTS
Overall, 420 people had a valid antibody test and 248 (59.1%) had a positive test, 238 had a valid HCV RNA test and 51 (21.4%) had a positive test. The prevalence of HCV RNA was higher among females (aPR 2.22 (95%CI 1.30,3.80) and those reporting unstable housing (aPR 1.86, 95%CI 1.06,3.29) or amphetamine use (aPR 1.80, 95%CI 1.04,3.13). It was lower among those reporting recent primary care engagement (aPR 0.60, 95%CI 0.37, 0.95).
There were 13 people with a new HCV RNA positive test. Of 64 people with a HCV RNA positive test, 34 had ≥1 follow-up, 18 of whom were HCV RNA negative and 16 had detectable HCV RNA and self-reported not being treated. Treatment was lower among people who were unstably housed compared to those stably housed at 38% and 77% respectively (p-value 0.039).
CONCLUSION
Among this cohort, unstable housing remains a barrier to HCV treatment. Policies enabling innovative treatment options tailored to the needs of people who are unstably housed are required.
|