Author: Traeger M, Pedrana A, Wilkinson A, Bramwell F, Membrey D, Nguyen L, El-Hayek C, Doyle J, Howell J, Thompson A, Guy R, Donovan B, Stoové M, Hellard M

Theme: Epidemiology & Public Health Research Year: 2019

Australian hepatitis C elimination strategies focus on testing and treatment uptake among people
who inject drugs (PWID) and retaining patients in clinical care. We describe HCV testing and linkage
to treatment among patients attending health services in Victoria, Australia post-DAA introduction.
Patient data were retrospectively extracted from 17 clinics providing services targeting PWID and
participating in the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance
(ACCESS). We calculated the annual number of individuals tested and proportion positive for HCV
antibodies and RNA. Among antibody-positive patients, we calculated the proportion who had a
reflexive RNA test (performed on the same antibody-positive blood collection), and the proportion
RNA tested within 3 months, annually. The proportion prescribed DAA treatment within 3 months of
a positive RNA result was calculated.
The proportion of patients tested for HCV antibodies with a positive result was 14.3% (608/4255),
18.0% (748/4153) and 14.7% (677/4595) in 2016, 2017 and 2018, respectively. Between 2016-2018
the annual proportion of antibody-positive patients receiving reflexive RNA testing after a positive
antibody result increased from 62.5%, to 73.7%, to 77.8%; the proportion with RNA testing within 3
months also increased from 73.4%, to 81.3%, to 84.3%. The annual proportion of patients tested for
HCV RNA with a positive result was 68.7% (1180/1717), 44.4% (850/1913) and 32.3% (513/1590)
from 2016-2018, demonstrating treatment impact. The proportion of patients with RNA-positive
results prescribed DAA treatment within 3 months increased from 22.4%, 34.6%, to 41.1% over
Conclusion: While HCV screening remained relatively stable from 2016-2018, follow-up RNA testing
among antibody-positive patients increased. Linkage to treatment improved, however less than half
of RNA-positive individuals in 2018 were prescribed treatment within 3 months, and the absolute
number of patients treated decreased. To sustain treatment impact, efforts to increase in HCV
testing are needed.
Disclosure of Interest Statement:
The authors acknowledge funding support through a National Health and Medical Research Council
Partnership grant, supported by Gilead Sciences. The Burnet also receives funding support
from the, Abbvie, GSK and Merck for investigator initiated research. The authors gratefully
acknowledge the contribution of ACCESS participants, implementing sites and staff.

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