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. 2019 Aug;39(8):1400-1407.
doi: 10.1111/liv.14043. Epub 2019 Feb 24.

Disparities in uptake of direct-acting antiviral therapy for hepatitis C among people who inject drugs in a Canadian setting

M Eugenia Socías  1   2 , Lianping Ti  2   3 , Evan Wood  1   2 , Ekaterina Nosova  1 , Mark Hull  2   3 , Kanna Hayashi  1   4 , Kora Debeck  1   4 , M-J Milloy  1   2
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Disparities in uptake of direct-acting antiviral therapy for hepatitis C among people who inject drugs in a Canadian setting

M Eugenia Socías et al. Liver Int. 2019 Aug.

Abstract

Background & aims: Despite the high burden of hepatitis C virus (HCV) infection among people who inject drugs (PWID), uptake of interferon-based therapies has been extremely low. Increasing availability of direct-acting antiviral (DAA)-based therapies offers the possibility of rapid treatment expansion with the goal of controlling the HCV epidemic. We evaluated DAA-based treatment uptake among HCV-positive PWID in Vancouver after introduction of DAAs in the government drug formulary.

Methods: Using data from three cohorts of PWID in Vancouver, Canada, we investigated factors associated with DAA-therapies uptake among participants with HCV between April 2015 and November 2017.

Results: Of the 915 HCV-positive PWID, 611 (66.8%) were recent PWID and 369 (40.3%) had HIV coinfection. During the study period, 146 (16.0%) initiated DAA-therapies, a rate of 6.0 per 100 person-year, with higher initiation rates among non-recent PWID and an increasing trend over time. In multivariable analysis, HIV coinfection (Adjusted Odds Ratio [AOR] = 2.29, 95% Confidence Interval [CI]: 1.55-3.40), white race (AOR = 1.56, 95% CI: 1.05-2.35), and engagement in HCV care (AOR = 1.94, 95% CI: 1.31-2.90) were positively associated with DAA-therapies uptake, while high-risk drinking (AOR = 0.47, 95% CI: 0.23-0.88) and daily crack use were negatively associated (AOR = 0.41, 95% CI: 0.17-0.85). Among recent PWID, engagement in opioid agonist therapy emerged as an independent correlate of DAA uptake.

Conclusions: Despite increases in HCV treatment uptake among PWID after the introduction of DAAs in our setting, disparities in access remain. Social-structural and behavioural barriers to HCV care should be addressed for the success of any HCV elimination strategy.

Keywords: HIV; direct-acting-antiviral; hepatitis C; people who inject drugs.

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Conflict of interest statement

Conflict of interest: The University of British Columbia has received unstructured funding from NG Biomed, Ltd. to support M-JM. All other authors declare no conflict of interests.

Figures

Figure 1.
Figure 1.. Trends in DAA-based therapy uptake among PWID with chronic HCV infection, Vancouver, Canada (April 2015 - November 2017)
DAA, direct acting antiviral. PY, person years. PWID, people who inject drugs.
See this image and copyright information in PMC

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