In the Journals

Unrestricted DAA access improves HCV treatment uptake among PWIDs

Data from Australia’s annual bio-behavioral surveillance of people who inject drugs attending needle syringe programs between 2015 and 2017 showed a significant increase in hepatitis C treatment uptake and decrease in viremic prevalence, especially among older patients and those with a history of opioid substitution therapy.

“Australia implemented unrestricted subsidized access to [direct-acting antiviral (DAA)] therapy in March 2016, ensuring that all adults with chronic HCV were eligible for DAA therapy irrespective of liver disease stage and ongoing drug use,” Jenny Iverson, PhD, from the University of New South Wales in Australia, and colleagues wrote. “The initial DAA uptake in Australia, including the high coverage of people with HCV-related cirrhosis, has laid a solid foundation for achieving the WHO elimination goals.”

Iversen and colleagues gathered data from the Australian Needle Syringe Program Survey to examine the impact of DAA access among a national sample of PWIDs.

The study sample included 2,046 survey participants from 2015, 1,995 participants from 2016, and 2,380 participants from 2017 whom the researchers deemed eligible from their anti-HCV results.

Excluding patients with spontaneous clearance, HCV treatment initiation increased from 10% in 2015 to 41% in 2017 (P < .001). Treatment-induced clearance increased from 4% in 2015, to 17% in 2016, to 31% in 2017 (P < .001). HCV viremic prevalence declined from 43% in 2015, to 32% in 2016, to 25% in 2017 (P < .001).

Multivariate analysis showed that older age, such as 50 years or older (OR = 1.82; 95% CI, 1.09-3.06) and those aged between 44 years and 49 years (OR = 1.75; 95% CI, 1.03-3) compared with those aged 37 years or younger, and a history of opioid substitution therapy (OR = 2.06; 95% CI, 1.3-3.26) correlated independently with HCV treatment.

The researchers did not find any association between HCV treatment and potentially vulnerable subpopulations of PWIDs, such as those who injected daily or more frequently, those with a history of incarceration, or those residing in regional or remote areas.

“It is crucial to have a robust surveillance system to monitor DAA treatment uptake, prevalence of HCV RNA infection, HCV incidence and HCV reinfection among PWID,” the researchers wrote.

Iversen and colleagues highlighted that Australia is in “an enviable position” with unrestricted subsidized access to DAA therapy for PWIDs. They advise that countries in which PWIDs are the predominant group at risk for transmission, scaling up DAA therapy in settings with currently limited access and maintaining the momentum of scaled-up HCV treatment will be necessary to achieve the WHO HCV elimination targets.

“This study provides evidence that relatively high rates of HCV treatment can be achieved among PWID when DAA therapy is made available without restrictions,” the researchers concluded. – by Talitha Bennett

Disclosure: Iversen reports no relevant financial disclosures. Please see the full study for the other authors’ relevant financial disclosures.

Data from Australia’s annual bio-behavioral surveillance of people who inject drugs attending needle syringe programs between 2015 and 2017 showed a significant increase in hepatitis C treatment uptake and decrease in viremic prevalence, especially among older patients and those with a history of opioid substitution therapy.

“Australia implemented unrestricted subsidized access to [direct-acting antiviral (DAA)] therapy in March 2016, ensuring that all adults with chronic HCV were eligible for DAA therapy irrespective of liver disease stage and ongoing drug use,” Jenny Iverson, PhD, from the University of New South Wales in Australia, and colleagues wrote. “The initial DAA uptake in Australia, including the high coverage of people with HCV-related cirrhosis, has laid a solid foundation for achieving the WHO elimination goals.”

Iversen and colleagues gathered data from the Australian Needle Syringe Program Survey to examine the impact of DAA access among a national sample of PWIDs.

The study sample included 2,046 survey participants from 2015, 1,995 participants from 2016, and 2,380 participants from 2017 whom the researchers deemed eligible from their anti-HCV results.

Excluding patients with spontaneous clearance, HCV treatment initiation increased from 10% in 2015 to 41% in 2017 (P < .001). Treatment-induced clearance increased from 4% in 2015, to 17% in 2016, to 31% in 2017 (P < .001). HCV viremic prevalence declined from 43% in 2015, to 32% in 2016, to 25% in 2017 (P < .001).

Multivariate analysis showed that older age, such as 50 years or older (OR = 1.82; 95% CI, 1.09-3.06) and those aged between 44 years and 49 years (OR = 1.75; 95% CI, 1.03-3) compared with those aged 37 years or younger, and a history of opioid substitution therapy (OR = 2.06; 95% CI, 1.3-3.26) correlated independently with HCV treatment.

The researchers did not find any association between HCV treatment and potentially vulnerable subpopulations of PWIDs, such as those who injected daily or more frequently, those with a history of incarceration, or those residing in regional or remote areas.

“It is crucial to have a robust surveillance system to monitor DAA treatment uptake, prevalence of HCV RNA infection, HCV incidence and HCV reinfection among PWID,” the researchers wrote.

Iversen and colleagues highlighted that Australia is in “an enviable position” with unrestricted subsidized access to DAA therapy for PWIDs. They advise that countries in which PWIDs are the predominant group at risk for transmission, scaling up DAA therapy in settings with currently limited access and maintaining the momentum of scaled-up HCV treatment will be necessary to achieve the WHO HCV elimination targets.

“This study provides evidence that relatively high rates of HCV treatment can be achieved among PWID when DAA therapy is made available without restrictions,” the researchers concluded. – by Talitha Bennett

Disclosure: Iversen reports no relevant financial disclosures. Please see the full study for the other authors’ relevant financial disclosures.