Heather Valerio1, Maryam Alavi1, David Silk1, Carla Treloar2, Marianne Martinello1, Andrew Milat3,4, Adrian Dunlop5,6, Jo Holden7, Charles Henderson8, Janaki Amin1,9, Phillip Read1,10, Philippa Marks1, Louisa Degenhardt11, Jeremy Hayllar12, David Reid13, Carla Gorton14, Thao Lam15, Gregory J Dore1, Jason Grebely1. 1. The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia. 2. Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia. 3. Centre for Epidemiology and Evidence, NSW Health, Sydney, New South Wales, Australia. 4. School of Public Health, University of Sydney, Sydney, New South Wales, Australia. 5. Centre for Translational Neuroscience and Mental Health, Hunter Medical Research Institute and University of Newcastle, Newcastle, New South Wales, Australia. 6. Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, New South Wales, Australia. 7. Population Health Strategy and Performance, NSW Health, Sydney, New South Wales, Australia. 8. NSW Users and AIDS Association, Sydney, New South Wales, Australia. 9. Macquarie University, Sydney, New South Wales, Australia. 10. Kirketon Road Centre, Sydney, New South Wales, Australia. 11. National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia. 12. Alcohol and Drug Service, Metro North Mental Health, Metro North Hospital and Health Service, Brisbane, Queensland, Australia. 13. The Orana Centre, Illawarra Shoalhaven LHD, Wollongong, New South Wales, Australia. 14. Cairns Sexual Health Service, Cairns, Queensland, Australia. 15. Drug Health, Western Sydney Local Health District, Sydney, New South Wales, Australia.
Abstract
BACKGROUND: Evaluating progress towards hepatitis C virus (HCV) elimination is critical. This study estimated prevalence of current HCV infection and HCV treatment uptake among people who inject drugs (PWID) in Australia. METHODS: The Enhancing Treatment of Hepatitis C in Opioid Substitution Settings Engage is an observational study of PWID attending drug treatment clinics and needle and syringe programs (NSPs). Participants completed a questionnaire including self-reported treatment history and underwent point-of-care HCV RNA testing (Xpert HCV Viral Load Fingerstick; Cepheid). RESULTS: Between May 2018 and September 2019, 1443 participants were enrolled (64% injected drugs in the last month, 74% receiving opioid agonist therapy [OAT]). HCV infection status was uninfected (28%), spontaneous clearance (16%), treatment-induced clearance (32%), and current infection (24%). Current HCV was more likely among people who were homeless (adjusted odds ratio, 1.47; 95% confidence interval, 1.00-2.16), incarcerated in the previous year (2.04; 1.38-3.02), and those injecting drugs daily or more (2.26; 1.43-2.42). Among those with previous chronic or current HCV, 66% (n = 520/788) reported HCV treatment. In adjusted analysis, HCV treatment was lower among females (.68; .48-.95), participants who were homeless (.59; .38-.96), and those injecting daily or more (.51; .31-.89). People aged ≥45 years (1.46; 1.06-2.01) and people receiving OAT (2.62; 1.52-4.51) were more likely to report HCV treatment. CONCLUSIONS: Unrestricted direct-acting antiviral therapy access in Australia has yielded high treatment uptake among PWID attending drug treatment and NSPs, with a marked decline in HCV prevalence. To achieve elimination, PWID with greater marginalization may require additional support and tailored strategies to enhance treatment.
BACKGROUND: Evaluating progress towards hepatitis C virus (HCV) elimination is critical. This study estimated prevalence of current HCV infection and HCV treatment uptake among people who inject drugs (PWID) in Australia. METHODS: The Enhancing Treatment of Hepatitis C in Opioid Substitution Settings Engage is an observational study of PWID attending drug treatment clinics and needle and syringe programs (NSPs). Participants completed a questionnaire including self-reported treatment history and underwent point-of-care HCV RNA testing (Xpert HCV Viral Load Fingerstick; Cepheid). RESULTS: Between May 2018 and September 2019, 1443 participants were enrolled (64% injected drugs in the last month, 74% receiving opioid agonist therapy [OAT]). HCV infection status was uninfected (28%), spontaneous clearance (16%), treatment-induced clearance (32%), and current infection (24%). Current HCV was more likely among people who were homeless (adjusted odds ratio, 1.47; 95% confidence interval, 1.00-2.16), incarcerated in the previous year (2.04; 1.38-3.02), and those injecting drugs daily or more (2.26; 1.43-2.42). Among those with previous chronic or current HCV, 66% (n = 520/788) reported HCV treatment. In adjusted analysis, HCV treatment was lower among females (.68; .48-.95), participants who were homeless (.59; .38-.96), and those injecting daily or more (.51; .31-.89). People aged ≥45 years (1.46; 1.06-2.01) and people receiving OAT (2.62; 1.52-4.51) were more likely to report HCV treatment. CONCLUSIONS: Unrestricted direct-acting antiviral therapy access in Australia has yielded high treatment uptake among PWID attending drug treatment and NSPs, with a marked decline in HCV prevalence. To achieve elimination, PWID with greater marginalization may require additional support and tailored strategies to enhance treatment.
Authors: Margaret A Maglione; Laura Raaen; Christine Chen; Gulrez Azhar; Nima Shahidinia; Mimi Shen; Ervant Maksabedian; Roberta M Shanman; Sydne Newberry; Susanne Hempel Journal: J Subst Abuse Treat Date: 2018-03-13
Authors: Evan B Cunningham; Behzad Hajarizadeh; Janaki Amin; Neil Bretana; Gregory J Dore; Louisa Degenhardt; Sarah Larney; Fabio Luciani; Andrew R Lloyd; Jason Grebely Journal: Int J Drug Policy Date: 2018-01-24
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