Increased Uptake of HCV Treatment Associated With Scale-Up of Direct-Acting Antivirals in Community Settings: A National Record-Linkage Study

Author: Shanley Smith Alan Yeung John Dillon Stephen Barclay Peter Hayes Kate Templeton Rory Gunson Peter Bramley Andrew Fraser Nicholas Kennedy David Goldberg Scott McDonald Andrew Hamish Innes Sharon Hutchinson

Theme: Epidemiology & Public Health Research Year: 2022

Background: With the introduction of highly-effective and easy to administer direct-acting antivirals
(DAAs), Scottish Government recommended that HCV therapy be delivered in community settings
(including prisons); a strategic change aimed to facilitate greater access and prompt uptake of the
new therapies for populations such as people who inject drugs (PWID). We examined to what extent
this policy had been implemented and the change in uptake of therapy within 12 months following a
new HCV diagnosis pre- and post- DAAs.
Methods: Using the national HCV diagnosis and clinical databases, 9,604 individuals newly diagnosed
with chronic HCV during 2010-2019 in Scotland were linked to treatment data up to March 2021.
Logistic regression was used to assess uptake of HCV therapy within 12 months of a new chronic HCV
diagnosis pre- and post- DAAs.
Results: Among PWID treated in Scotland, a higher proportion were initiated on therapy in
community settings in the established DAA period (47% in 2018-2019, relating to a period without
prioritisation for advanced liver disease) compared to the pre-DAA period (22% in 2010-14). The
proportion of individuals treated within 12 months of a new chronic diagnosis increased markedly
between pre-DAA (20%) and established DAA periods (61%) for all individuals and similarly for those
diagnosed in drug services and prisons (11% and 61%, respectively). Higher odds of treatment
initiation within 12 months of new chronic HCV diagnosis were associated with diagnosis in the
established DAA, compared to pre-DAA, period (aOR = 14.5, 95% CI: 11.9 – 17.7) overall and for
those diagnosed in drug services and prisons (aOR = 31.1, 95% CI: 20.0 – 48.3).
Conclusion: Our data indicate that the approach adopted to scale-up DAAs in Scotland, with
increased delivery in community settings, has facilitated greater uptake of HCV treatment,
particularly for individuals diagnosed in drugs services and prisons.
Disclosure of Interest statement: SJ Hutchinson received honoraria from Gilead; PC Hayes has been paid to speak at meetings/had travel support with AbbVie, BMS, Eisai Ltd, Falk, Ferring, Gilead, Gore, Janssen, Lundbeck, MSD, Norgine, Novartis, ONO Pharmaceuticals, Pfizer and Roche, unrelated to the submitted work. All remaining authors have nothing to disclose.

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