Awareness of hepatitis C virus infection status among people who inject drugs in a setting of universal direct-acting antiviral therapy: The ETHOS Engage study

Heather Valerio; Anna Conway; Maryam Alavi; Carla Treloar; David Silk; Carolyn Murray; Charles Henderson; Janaki Amin; Phillip Read; Louisa Degenhardt; Michael Christmass; Mark Montebello; Gregory J Dore; Jason Grebely; ETHOS Engage Study Group

doi:10.1016/j.drugpo.2022.103876

Awareness of hepatitis C virus infection status among people who inject drugs in a setting of universal direct-acting antiviral therapy: The ETHOS Engage study

Int J Drug Policy. 2022 Dec:110:103876. doi: 10.1016/j.drugpo.2022.103876. Epub 2022 Oct 12.

Authors

Affiliations

¹ The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia. Electronic address: hvalerio@kirby.unsw.edu.au.
² The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia.
³ The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia.
⁴ Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia.
⁵ Population Health Strategy & Performance, NSW Health, New South Wales, Australia.
⁶ NSW Users and AIDS Association, New South Wales, Australia.
⁷ Department of Health Sciences, Macquarie University, Sydney, New South Wales, Australia.
⁸ Kirketon Road Centre, Sydney, New South Wales, Australia.
⁹ National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia.
¹⁰ Next Step Drug and Alcohol Service, Perth, Western Australia, Australia; National Drug Research Institute, Curtin University, Perth, Western Australia, Australia.
¹¹ North Sydney Local Health District, Sydney, New South Wales, Australia.

PMID: 36240657
DOI: 10.1016/j.drugpo.2022.103876

Abstract

Background: Awareness of hepatitis C virus (HCV) infection status among people who inject drugs (PWID) can empower people with diagnosis, enable treatment uptake, and facilitate elimination. We aimed to evaluate awareness of HCV infection status among a large national cohort of PWID in an era of unrestricted HCV treatment.

Methods: ETHOS Engage is an observational cohort study of PWID attending drug treatment clinics and needle and syringe programs in Australia. Participants completed a questionnaire containing self-reported HCV data (including infection status: never tested, tested/unknown, no current HCV infection [HCV RNA not detectable], current HCV infection [HCV RNA detectable]) and underwent point-of-care HCV RNA testing (Xpert® HCV Viral Load Fingerstick). Awareness was defined as concordant self-reported HCV status and test result. Awareness was assessed among all participants, those with current HCV infection, and participants who reported a lifetime history of HCV treatment. Logistic regression was used to assess factors associated with awareness in these three populations.

Results: Among 2,305 PWID, 65% (n=1,506) were aware of their HCV infection status (self-reported HCV status matched HCV point-of-care result). Awareness of infection status was higher among those who were not currently infected (70%, n=1,281/1,818) compared to those with current HCV infection (46%, n=225/487). After adjusting, those with current HCV infection were less likely to be aware of infection status (aOR: 0.40, 95%CI: 0.30, 0.45). Among those who reported a lifetime history of HCV treatment, 71% (n=592/829) were aware of their HCV infection status.

Conclusion: Among a large cohort of PWID in Australia, awareness of HCV infection status is sub-optimal, with particularly concerning levels among those with active infection. Increased and simplified testing, post-test counselling, and post-treatment monitoring is warranted.

Keywords: Awareness; Hepatitis C virus; Infection status; People who inject drugs.

Publication types

Observational Study

MeSH terms

Antiviral Agents / therapeutic use
Drug Users*
Hepacivirus / genetics
Hepatitis C* / complications
Hepatitis C* / drug therapy
Hepatitis C* / epidemiology
Hepatitis C, Chronic* / drug therapy
Humans
RNA / therapeutic use
Substance Abuse, Intravenous* / complications
Substance Abuse, Intravenous* / drug therapy
Substance Abuse, Intravenous* / epidemiology

Substances

Antiviral Agents
RNA