Theme: Clinical Research Year: 2019
Background: Gaps in hepatitis C virus (HCV) testing and diagnosis, liver disease assessment and
treatment uptake among people who inject drugs (PWID) persist. We aimed to describe the cascade
of HCV care among PWID in Australia, prior to and following unrestricted access to direct-acting
antiviral (DAA) treatment uptake.
Methods: Participants enrolled in an observational cohort study during liver health campaign days
between 2014 and 2018 provided finger-stick whole-blood samples for dried blood spot and Xpert®
HCV Viral Load, and venepuncture samples. Participants received transient elastography and clinical
assessment by a nurse or general practitioner. Clinical follow-up was recommended 2-12 weeks
Results: Among 839 participants (mean age 43 years), 66% were male (n=550), 64% (n=537) injected
drugs in the previous month, and 67% (n=560) reported currently receiving opioid substitution
therapy. Overall, 45% (n=380) had detectable HCV RNA, of whom 23% (n=86) received HCV
treatment within 12 months of enrolment. HCV treatment uptake increased from 2% in pre-DAA era
to 38% in DAA era. Significant liver fibrosis (F2–F4) was more common in participants with HCV
infection (38%) than those without (19%). Older age (≥ 51 years group: aOR, 3.17; 95% CI, 1.87–
5.34), BMI ≥30 (aOR, 2.51; 95% CI, 1.66–3.81) and detectable HCV RNA (aOR, 2.79; 95% CI, 1.95–
3.99) were associated with significant fibrosis. Age 50 years or older (aOR, 2.88; 95% CI, 1.18–7.04)
and attending a clinical follow-up with nurse (aOR, 3.19; 95% CI, 1.61–6.32) or physician (aOR, 11.83;
95% CI, 4.89–28.59) were associated with HCV treatment uptake.
Conclusion: HCV treatment uptake among PWID in Australia has increased markedly in the DAA era.
Innovative models of care that address the social and structural determinants of access to care are
required to further enhance treatment uptake.
Disclosure of interest Statement: The Kirby Institute is funded by the Australian Government
Department of Health and Ageing. The views expressed in this publication do not necessarily
represent the position of the Australian Government. SB is supported by an Australian Postgraduate
Award from UNSW Sydney. JG is supported by a NHMRC Career Development Fellowship. LM is
supported by a NHMRC Senior Research Fellowship. GJD is supported by a NHMRC Practitioner
Research Fellowship.GD is a consultant/advisor and has received research grants from Abbvie,
Gilead and Merck. JG is a consultant/advisor and has received research grants from Abbvie, Cepheid,
Gilead Sciences and Merck/MSD.