High uptake of direct-acting antiviral therapy for hepatitis C virus and reduction in population-level viremic prevalence: Progress toward achieving hepatitis C elimination among people who inject drugs in Australia

Author: Heather Valerio, Maryam Alavi, David Silk, Carla Treloar, Andrew Milat, Adrian Dunlop, Jo Holden, Charles Henderson, Janaki Amin, Phillip Read, Louisa Degenhardt, Gregory J Dore, Jason Grebely

Theme: Epidemiology & Public Health Research Year: 2019

Background: People who inject drugs (PWID) are at high risk of HCV infection but have poor access to
treatment in many settings. Unrestricted direct-acting antiviral (DAA) therapy has been available in
Australia since March 2016. Our objective was to evaluate burden of HCV and the uptake and factors
associated with HCV testing and treatment among PWID in Australia in the DAA era.
Method: ETHOS Engage is an observational cohort study collecting behavioural and clinical data
among PWID attending drug treatment clinics and needle and syringe programs in Australia. All
participants underwent point-of-care HCV RNA testing via Xpert® HCV Viral Load Finger-Stick assay.
Logistic regression was used to identify factors associated with treatment uptake.
Results: Between May 2018-March 2019, 1,001 participants were enrolled. Overall, 67% had injected
drugs in the last month, 72% were receiving opioid substitution therapy (OST), 73% were ever HCVinfected (Ab+ve), and 60% had a history or testing consistent with prior or current chronic HCV. Among
those Ab+ve (n=734, 73%), 75% had previously been tested for HCV RNA. Among those ever with
chronic HCV (n=600, 60%), 59% had received treatment. Uptake of HCV therapy was high, including
among those with current and no OST (62%, 48%) injecting in last month (57%), and heroin (63%) and
amphetamine (56%) injecting in the last month. In adjusted analysis, males (vs. females; adjusted
odds ratio 1.60, p=0.015) and people receiving OST (vs. no OST; 1.76, p=0.007) were more likely to
have received HCV treatment. Among those with valid point-of-care results, 27% were currently HCV
RNA+ve, 30% had treatment-induced clearance, 17% spontaneous clearance, and 26% were HCV Abve.
Conclusion: Unrestricted DAA access in Australia has yielded high treatment uptake and more than
halved HCV viraemia among PWID attending drug treatment and needle syringe programs. To achieve
elimination, sub-populations of PWID may require additional support to encourage screening and
engagement with HCV care.
Disclosure of Interest statement: None provided

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