Progress Towards Elimination of Hepatitis C Infection Among People Who Inject Drugs in Australia: The ETHOS Engage Study

Heather Valerio; Maryam Alavi; David Silk; Carla Treloar; Marianne Martinello; Andrew Milat; Adrian Dunlop; Jo Holden; Charles Henderson; Janaki Amin; Phillip Read; Philippa Marks; Louisa Degenhardt; Jeremy Hayllar; David Reid; Carla Gorton; Thao Lam; Gregory J Dore; Jason Grebely

doi:10.1093/cid/ciaa571

Progress Towards Elimination of Hepatitis C Infection Among People Who Inject Drugs in Australia: The ETHOS Engage Study

Clin Infect Dis. 2021 Jul 1;73(1):e69-e78. doi: 10.1093/cid/ciaa571.

Authors

Heather Valerio¹, Maryam Alavi¹, David Silk¹, Carla Treloar², Marianne Martinello¹, Andrew Milat^{3

4}, Adrian Dunlop^{5

6}, Jo Holden⁷, Charles Henderson⁸, Janaki Amin^{1

9}, Phillip Read^{1

10}, Philippa Marks¹, Louisa Degenhardt¹¹, Jeremy Hayllar¹², David Reid¹³, Carla Gorton¹⁴, Thao Lam¹⁵, Gregory J Dore¹, Jason Grebely¹

Affiliations

¹ The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia.
² Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia.
³ Centre for Epidemiology and Evidence, NSW Health, Sydney, New South Wales, Australia.
⁴ School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
⁵ Centre for Translational Neuroscience and Mental Health, Hunter Medical Research Institute and University of Newcastle, Newcastle, New South Wales, Australia.
⁶ Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, New South Wales, Australia.
⁷ Population Health Strategy and Performance, NSW Health, Sydney, New South Wales, Australia.
⁸ NSW Users and AIDS Association, Sydney, New South Wales, Australia.
⁹ Macquarie University, Sydney, New South Wales, Australia.
¹⁰ Kirketon Road Centre, Sydney, New South Wales, Australia.
¹¹ National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia.
¹² Alcohol and Drug Service, Metro North Mental Health, Metro North Hospital and Health Service, Brisbane, Queensland, Australia.
¹³ The Orana Centre, Illawarra Shoalhaven LHD, Wollongong, New South Wales, Australia.
¹⁴ Cairns Sexual Health Service, Cairns, Queensland, Australia.
¹⁵ Drug Health, Western Sydney Local Health District, Sydney, New South Wales, Australia.

Abstract

Background: Evaluating progress towards hepatitis C virus (HCV) elimination is critical. This study estimated prevalence of current HCV infection and HCV treatment uptake among people who inject drugs (PWID) in Australia.

Methods: The Enhancing Treatment of Hepatitis C in Opioid Substitution Settings Engage is an observational study of PWID attending drug treatment clinics and needle and syringe programs (NSPs). Participants completed a questionnaire including self-reported treatment history and underwent point-of-care HCV RNA testing (Xpert HCV Viral Load Fingerstick; Cepheid).

Results: Between May 2018 and September 2019, 1443 participants were enrolled (64% injected drugs in the last month, 74% receiving opioid agonist therapy [OAT]). HCV infection status was uninfected (28%), spontaneous clearance (16%), treatment-induced clearance (32%), and current infection (24%). Current HCV was more likely among people who were homeless (adjusted odds ratio, 1.47; 95% confidence interval, 1.00-2.16), incarcerated in the previous year (2.04; 1.38-3.02), and those injecting drugs daily or more (2.26; 1.43-2.42). Among those with previous chronic or current HCV, 66% (n = 520/788) reported HCV treatment. In adjusted analysis, HCV treatment was lower among females (.68; .48-.95), participants who were homeless (.59; .38-.96), and those injecting daily or more (.51; .31-.89). People aged ≥45 years (1.46; 1.06-2.01) and people receiving OAT (2.62; 1.52-4.51) were more likely to report HCV treatment.

Conclusions: Unrestricted direct-acting antiviral therapy access in Australia has yielded high treatment uptake among PWID attending drug treatment and NSPs, with a marked decline in HCV prevalence. To achieve elimination, PWID with greater marginalization may require additional support and tailored strategies to enhance treatment.

Keywords: direct-acting antivirals; hepatitis C elimination; hepatitis C virus; people who inject drugs.

Publication types

Observational Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Antiviral Agents / therapeutic use
Australia / epidemiology
Female
Hepatitis C* / drug therapy
Hepatitis C* / epidemiology
Hepatitis C, Chronic* / drug therapy
Hepatitis C, Chronic* / epidemiology
Humans
Opiate Substitution Treatment
Pharmaceutical Preparations*
Substance Abuse, Intravenous* / complications
Substance Abuse, Intravenous* / drug therapy
Substance Abuse, Intravenous* / epidemiology

Substances

Antiviral Agents
Pharmaceutical Preparations