Hepatitis C continuum of care and utilization of healthcare and harm reduction services among persons who inject drugs in Seattle

Abstract

Background: To describe the "continuum of care" for hepatitis C virus (HCV) and related health service utilization among persons who inject drugs (PWID) in the Seattle metropolitan area.

Methods: The study analyzed data from the 2015 National HIV Behavioral Surveillance system focused on PWID, which included local questions on HCV treatment and testing. We calculated respondent driven sampling (RDS)-adjusted percentages of participants who had completed each step of the care continuum and compared healthcare harm reduction services among participants who were HCV + vs. HCV- using bivariate analyses.

Results: 513 PWID were screened for HCV antibodies (Ab). Of those, 59.7% were HCV Ab+. Among those HCV Ab+, 86.4% had been tested for HCV at least once; 69.9% reported a previous diagnosis. Of those diagnosed, 55.9% had received a confirmatory test, 17.2% had ever received any medications for HCV, and 7.2% had completed treatment. The majority of HCV Ab + participants had seen a health care provider in the past 12 months (85.6%).

Conclusions: There is a large gap between HCV screening and treatment among Seattle area PWID.

Keywords: Continuum of care; Hepatitis C; Persons who inject drugs.

Figure 1.

Seattle Area National HIV Behavioral Surveillance Injection Drug Use (IDU4) Survey Participants, 2015

Figure 2:. Hepatitis C Virus (HCV) Continuum of Care among HCV Seropositive People Who Inject Drugs (PWID), Seattle Area National HIV Behavioral Surveillance Injection Drug Use (IDU4) Survey, 2015 (N=338)

(1) Among 513 participants who completed HCV antibody testing; 338 (65.9%, crude; 59.7%, RDS-weighted) were positive. (2) “Have you ever been tested for hepatitis C infection?” (3) “Has a doctor, nurse, or other health care provider ever told you that you had hepatitis C?” (4) “Did you get a confirmatory hepatitis C RNA test, also known as a viral load test?” Note: an additional 35 (15%, crude; 18.9%, RDS-weighted) people answered “I don’t know”. (5) “Have you ever taken medicine to treat your hepatitis C infection?” (6) Answered: “Already completed treatment” to “Would you be interested in getting the new treatments for hepatitis C?” *Questions 4–6 were designed to be asked in the local survey to people who reported a prior HCV diagnosis (n=247). Thirteen people who reported a prior HCV diagnosis were miscoded by interviewers and not asked these questions, thus the sample size for these estimates is N=234.