Work

Uptake of HCV treatment among people who inject drugs in the direct-acting antiviral era in a Canadian setting

Year: 2018

Type: article

Abstract: Background: Despite high burden of hepatitis C (HCV) infection among people who inject drugs (PWID), treatment uptake of Interferon-based therapies in this population has been extremely low. For example, in Vancouver, Canada, rates 1.1% per person-year have been documented. Increasing availability of highly efficacious and safer direct-acting antiviral (DAA)-based therapies offers the possibility of rapid treatment expansion with the goal of controlling the HCV epidemic. We sought to evaluate uptake of DAA-based treatments among HCV-positive PWID after introduction of these regimens in the provincial drug formulary. Methods & Materials: Data was drawn from three prospective cohorts of PWID in Vancouver, Canada, a setting of universal no-cost medical care, between June 2015 and November 2016. Using logistic regression, we investigated factors associated with DAA-regimens uptake among participants with chronic HCV infection. Results: In total, 861 HCV-positive PWID were included, of whom 355 (41.2%) were co-infected with HIV. During the study period, 85 (9.8%) initiated DAA-therapies, a rate of 6.5% per person-year. In multivariable analysis, HIV-coinfected participants (Adjusted Odds Ratio [AOR] = 1.92, 95% Confidence Interval [CI]: 1.18–3.17) and those in HCV care (AOR = 3.66, 95% CI: 2.14–6.56) had increased odds of having initiated DAA-therapies, while those engaged in prohibited income generation (e.g., drug dealing, sex work) had decreased odds (AOR = 0.43, 95% CI: 0.24–0.76). Conclusion: Despite increases in HCV treatment uptake among PWID after introduction of DAA-regimens in our setting, rates remain low. HIV-coinfected participants were more likely to initiate treatment, suggesting that integrated models of HIV/HCV care may have potential to expand HCV treatment to PWID, especially given high rates of co-infection in this population. Socio-economic vulnerability should also be addressed for the success of any HCV elimination strategy.

Source: International Journal of Infectious Diseases

DOI: 10.1016/j.ijid.2018.04.4282