Joseph S Doyle1,2, Daniela K van Santen1,3, David Iser2,4, Joe Sasadeusz2,5, Mark O'Reilly6, Brendan Harney1,2, Michael W Traeger1,3, Janine Roney2, Julia C Cutts1, Anna L Bowring1, Rebecca Winter1,4, Nick Medland7, Christopher K Fairley7, Richard Moore8, B K Tee9, Jason Asselin1, Carol El-Hayek1, Jennifer F Hoy2, Gail V Matthews10, Maria Prins11,12, Mark A Stoové1,3, Margaret E Hellard1,2,3,13. 1. Burnet Institute, Melbourne, Victoria, Australia. 2. Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Victoria, Australia. 3. School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. 4. Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia. 5. Victorian Infectious Diseases Service at the Doherty Institute, Melbourne, Victoria, Australia. 6. Prahran Market Clinic, Melbourne, Victoria, Australia. 7. Melbourne Sexual Health Centre, Alfred Health and Central Clinical School Monash University, Carlton, Victoria, Australia. 8. Northside Clinic, Fitzroy North, Victoria, Australia. 9. Centre Clinic, Melbourne, Victoria, Australia. 10. Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia. 11. Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Infection and Immunity Institute Amsterdam, The Netherlands. 12. Public Health Service of Amsterdam, Amsterdam, The Netherlands. 13. Doherty Institute and Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
Abstract
BACKGROUND: Gay and bisexual men (GBM) are a key population affected by human immunodeficiency virus (HIV) and hepatitis C virus (HCV) coinfection. We aimed to measure HCV treatment effectiveness and to determine the population impact of treatment scale-up on HCV prevalence and incidence longitudinally among GBM. METHODS: The co-EC Study (Enhancing Care and Treatment Among HCV/HIV Coinfected Individuals to Eliminate Hepatitis C Transmission) was an implementation trial providing HCV direct-acting antiviral treatment in Melbourne, Australia, during 2016-2018. Individuals with HCV/HIV coinfection were prospectively enrolled from primary and tertiary care services. HCV viremic prevalence and HCV antibody/viremic incidence were measured using a statewide, linked, surveillance system. RESULTS: Among 200 participants recruited, 186 initiated treatment during the study period. Sustained virological response in primary care (98% [95% confidence interval {CI}, 93%-100%]) was not different to tertiary care (98% [95% CI, 86%-100%]). From 2012 to 2019, between 2434 and 3476 GBM with HIV infection attended our primary care sites annually, providing 13 801 person-years of follow-up; 50%-60% received an HCV test annually, and 10%-14% were anti-HCV positive. Among those anti-HCV positive, viremic prevalence declined 83% during the study (54% in 2016 to 9% in 2019). HCV incidence decreased 25% annually from 1.7/100 person-years in 2012 to 0.5/100 person-years in 2019 (incidence rate ratio, 0.75 [95% CI, .68-.83]; P < .001). CONCLUSIONS: High treatment effectiveness by nonspecialists demonstrates the feasibility of treatment scale-up in this population. Substantial declines in HCV incidence and prevalence among GBM provides proof-of-concept for HCV microelimination. CLINICAL TRIALS REGISTRATION: NCT02786758.
BACKGROUND: Gay and bisexual men (GBM) are a key population affected by human immunodeficiency virus (HIV) and hepatitis C virus (HCV) coinfection. We aimed to measure HCV treatment effectiveness and to determine the population impact of treatment scale-up on HCV prevalence and incidence longitudinally among GBM. METHODS: The co-EC Study (Enhancing Care and Treatment Among HCV/HIV Coinfected Individuals to Eliminate Hepatitis C Transmission) was an implementation trial providing HCV direct-acting antiviral treatment in Melbourne, Australia, during 2016-2018. Individuals with HCV/HIV coinfection were prospectively enrolled from primary and tertiary care services. HCV viremic prevalence and HCV antibody/viremic incidence were measured using a statewide, linked, surveillance system. RESULTS: Among 200 participants recruited, 186 initiated treatment during the study period. Sustained virological response in primary care (98% [95% confidence interval {CI}, 93%-100%]) was not different to tertiary care (98% [95% CI, 86%-100%]). From 2012 to 2019, between 2434 and 3476 GBM with HIV infection attended our primary care sites annually, providing 13 801 person-years of follow-up; 50%-60% received an HCV test annually, and 10%-14% were anti-HCV positive. Among those anti-HCV positive, viremic prevalence declined 83% during the study (54% in 2016 to 9% in 2019). HCV incidence decreased 25% annually from 1.7/100 person-years in 2012 to 0.5/100 person-years in 2019 (incidence rate ratio, 0.75 [95% CI, .68-.83]; P < .001). CONCLUSIONS: High treatment effectiveness by nonspecialists demonstrates the feasibility of treatment scale-up in this population. Substantial declines in HCV incidence and prevalence among GBM provides proof-of-concept for HCV microelimination. CLINICAL TRIALS REGISTRATION: NCT02786758.
Authors: Anna Lee Wilkinson; Alisa Pedrana; Michael W Traeger; Jason Asselin; Carol El-Hayek; Long Nguyen; Victoria Polkinghorne; Joseph S Doyle; Alexander J Thompson; Jessica Howell; Nick Scott; Wayne Dimech; Rebecca Guy; Margaret Hellard; Mark Stoové Journal: Epidemiol Infect Date: 2021-12-06 Impact factor: 2.451
Authors: Dr Nick Scott; Ms Anna Palmer; Mr Tom Tidhar; Prof Mark Stoove; Dr Rachel S Sacks-Davis; A/Prof Joseph S Doyle; Dr Alisa J Pedrana; Prof Alexander Thompson; Prof David P Wilson; Prof Margaret Hellard Journal: Lancet Reg Health West Pac Date: 2021-11-23
Authors: Sofia R Bartlett; Andrey Verich; Joanne Carson; Samira Hosseini-Hooshyar; Phillip Read; David Baker; Jeffrey J Post; Robert Finlayson; Mark Bloch; Joseph S Doyle; David Shaw; Margaret Hellard; Maria Martinez; Philippa Marks; Gregory J Dore; Gail V Matthews; Tanya Applegate; Marianne Martinello Journal: Health Sci Rep Date: 2022-08-18