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

Autor: Gliddon HD; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; National Public Health Specialty Training Programme, South West, United Kingdom., Ward Z; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, United Kingdom., Heinsbroek E; Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Service, UK Health Security Agency, London, United Kingdom., Croxford S; National Public Health Speciality Training Programme, West Midlands, United Kingdom., Edmundson C; Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Service, UK Health Security Agency, London, United Kingdom., Hope VD; Public Health Institute, Liverpool John Moores University, Liverpool, United Kingdom., Simmons R; Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Service, UK Health Security Agency, London, United Kingdom., Mitchell H; Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Service, UK Health Security Agency, London, United Kingdom., Hickman M; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, United Kingdom., Vickerman P; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, United Kingdom., Stone J; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, United Kingdom. Electronic address: jack.stone@bristol.ac.uk.
Jazyk: angličtina
Zdroj: The International journal on drug policy [Int J Drug Policy] 2024 Jan 12, pp. 104324. Date of Electronic Publication: 2024 Jan 12.
DOI: 10.1016/j.drugpo.2024.104324
Abstrakt: 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.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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