Has the HCV cascade of care changed among people who inject drugs in England since the introduction of direct-acting antivirals?

Harriet D Gliddon, Zoe D Ward, Ellen Heinsbroek, Sara Croxford, Claire Edmundson, Vivian Hope, Ruth Simmons, Matt Hickman, Peter T Vickerman, Jack Stone*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

Abstract

Background
In England, over 80 % of those with hepatitis C virus (HCV) infection have injected drugs. We quantified the HCV cascade of care (CoC) among people who inject drugs (PWID) in England and determined whether this improved after direct-acting antivirals (DAAs) were introduced.

Methods
We analysed data from nine rounds of national annual cross-sectional surveys of PWID recruited from drug services (2011–2019; N = 12,320). Study rounds were grouped as: 'Pre-DAAs’ (2011–2014), ‘Prioritised DAAs’ (2015–2016) and 'Unrestricted DAAs’ (2017–2019). Participants were anonymously tested for HCV antibodies and RNA and completed a short survey. We assessed the proportion of PWID recently (current/previous year) tested for HCV. For participants ever HCV treatment eligible (past chronic infection with history of treatment or current chronic infection), we assessed the CoC as: HCV testing (ever), received a positive test result, seen a specialist nurse/doctor, and ever treated. We used logistic regression to determine if individuals progressed through the CoC differently depending on time-period, whether time-period was associated with recent testing (all participants) and lifetime HCV treatment (ever eligible participants), and predictors of HCV testing and treatment in the Unrestricted DAAs period.

Results
The proportion of ever HCV treatment eligible PWID reporting lifetime HCV treatment increased from 12.5 % in the Pre-DAAs period to 25.6 % in the Unrestricted DAAs period (aOR:2.40, 95 %CI:1.95–2.96). There were also increases in seeing a specialist nurse/doctor. The largest loss in the CoC was at treatment for all time periods. During the Unrestricted DAAs period, recent (past year) homelessness (vs never, aOR:0.66, 95 %CI:0.45–0.97), duration of injecting (≤3 years vs >3 years; aOR:0.26, 95 %CI:0.12–0.60), never (vs current, aOR:0.31, 95 %CI:0.13–0.75) or previously being prescribed OAT (vs current, aOR:0.67, 95 %CI:0.47-0.95), and never using a NSP (vs past year, aOR:0.27, 95 %CI:0.08–0.89) were negatively associated with lifetime HCV treatment. The proportion of PWID reporting recent HCV testing was higher during Unrestricted DAAs (56 %) compared to Pre-DAAs (48 %; aOR:1.28, 95 %CI:1.06–1.54).

Conclusion
COC stages from seeing a specialist onwards improved after DAAs became widely available. Further improvements in HCV testing are needed to eliminate HCV in England.
Original languageEnglish
Article number104324
Number of pages8
JournalInternational Journal of Drug Policy
Early online date12 Jan 2024
DOIs
Publication statusE-pub ahead of print - 12 Jan 2024

Bibliographical note

Funding Information:
This research received funding from the following sources UK National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation at the University of Bristol ( NIHR200877 ); Wellcome Trust [ WT 226619/Z/22/Z ]; NIHR Health Technology Assessment grant ( NIHR128513 ). The funders had no role in the study design, in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the article for publication

Funding Information:
ZW, MH, PV, and JS acknowledge support from the NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol (NIHR200877). JS and PV acknowledge funding from the Wellcome Trust [WT 226619/Z/22/Z]. For the purpose of Open Access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission. ZW, JS and PV acknowledge funding from the NIHR Health Technology Assessment (HTA) programme (NIHR128513) All authors gratefully acknowledge the drug and alcohol services that have facilitated delivery of the UAM Survey, and the participants recruited for giving their time to take part. The authors declare that the work reported herein did not require ethics approval because it did not involve animal or human participation. This research received funding from the following sources UK National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation at the University of Bristol (NIHR200877); Wellcome Trust [WT 226619/Z/22/Z]; NIHR Health Technology Assessment grant (NIHR128513). The funders had no role in the study design, in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the article for publication

Publisher Copyright:
© 2024 The Author(s)

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