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

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.

Figure 1.

ETHOS Engage participant flowchart, current HCV status (N = 1468). *Determined by self-report. Abbreviations: ETHOS, Enhancing Treatment of Hepatitis C in Opioid Substitution Settings; HCV, hepatitis C virus; HCV Ab-ve, HCV antibody negative.

Figure 2.

Current HCV prevalence among ETHOS Engage participants with known point-of-care HCV RNA results (n = 1388). *Main drug injected in the last month. Data for participants injecting other drugs (n = 24) are not shown. Abbreviations: ETHOS, Enhancing Treatment of Hepatitis C in Opioid Substitution Settings; F, female; HCV, hepatitis C virus; HCV Ab-ve, HCV antibody negative; HCV RNA+ve, HCV RNA positive; M, male; m, month(s); Meth, methamphetamine; OAT, opioid agonist therapy; RNA+ve, RNA positive.

Figure 3.

Self-reported historical HCV treatment among ETHOS Engage participants with evidence of previous or current HCV infection (n = 788). *Main drug injected in the last month. Data for participants injecting other drugs (n = 24) are not shown. Abbreviations: ETHOS, Enhancing Treatment of Hepatitis C in Opioid Substitution Settings; F, female; HCV, hepatitis C virus; M, male; m, month(s); Meth, methamphetamine; OAT, opioid agonist therapy.