The impact of direct-acting antivirals on hepatitis C viraemia among people who inject drugs in England; real-world data 2011–2018

et al.

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


Background: Direct-acting antiviral (DAA) therapy for anybody with viraemic HCV infection has been scaled-up in England since 2017. To assess early impacts, we described trends in, and factors associated with, HCV viraemia among people who inject drugs (PWID). We also examined trends in self-reported treatment access.Methods: Bio-behavioural data from an annual, national surveillance survey of PWID (2011 to 2018) estimated trends in viraemic prevalence among HCV antibody-positive PWID. Multivariable logistic regression identified characteristics independently associated with viraemia. Trends in treatment access were examined for PWID with known infection.Findings: Between 2011 and 2016, viraemic prevalence among antibody-positive PWID remained stable (2011, 57.7%; 2016, 55.8%) but decreased in 2017 (49.4%) and 2018 (50.4%) (both p<0.001). After adjustment for demographic and behavioural characteristics, there remained significant reduction in viraemia in 2017 (adjusted odds ratio (aOR) 0.79, 95%CI 0.65-0.94) and 2018 (aOR 0.79, 95%CI 0.66-0.93) compared to 2016. Other factors associated with viraemia were male gender (aOR 1.68, 95%CI 1.53-1.86), geographical region, injecting in past year (aOR 1.26, 95%CI 1.13-1.41), imprisonment (aOR 1.14, 95%CI 1.04-1.31) and homelessness (aOR 1.17, 95%CI 1.04-1.31). Among non-viraemic PWID with known infection, the proportion reporting ever receiving treatment increased in 2017 (28.7%, p<0.001) and 2018 (38.9%, p<0.001) compared to 2016 (14.5%).Interpretation: There has been a small reduction in HCV viraemia among antibody-positive PWID in England since 2016, alongside DAA scale-up, and some indication that treatment access has improved in the same period. Population-level monitoring and focus on harm reduction is critical for achieving and evaluating elimination.
Original languageEnglish
Pages (from-to)1452-1463
Number of pages12
JournalJournal of Viral Hepatitis
Issue number10
Early online date16 Jul 2021
Publication statusPublished - 16 Jul 2021

Bibliographical note

Funding Information:
This study is funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme (Grant Reference Number RP‐PG‐0616‐20008). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care

Funding Information:
The UAM Survey was led by EH, SC, KS and EP and was implemented by EH, SC, KS, EP, CE and MB over the study period. VH had historical involvement with overseeing the Survey and provided topic area expertise. SI, JS and NH performed testing on dried blood spot samples. MH, SH, SM, VH and EH conceived and designed the EPIToPe study which this study contributes to. MB, EH and RS conceived the statistical analysis plan and MB performed the analyses and generation of result tables and figures with support from RH. MB drafted the manuscript, and all authors fed into the review process to develop the final manuscript. We also acknowledge support from NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation and HPRU in Blood Borne and Sexually Transmitted Infections.

Publisher Copyright:
© 2021 Crown copyright. Journal of Viral Hepatitis published by John Wiley & Sons Ltd. This article is published with the permission of the Controller of HMSO and the Queen's Printer for Scotland.


  • Direct-acting antivirals
  • Elimination
  • Hepatitis C virus
  • People who inject drugs
  • Treatment as prevention


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