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. 2021 Mar 1:220:108525.
doi: 10.1016/j.drugalcdep.2021.108525. Epub 2021 Jan 11.

Age and gender-specific hepatitis C continuum of care and predictors of direct acting antiviral treatment among persons who inject drugs in Seattle, Washington

Maria A Corcorran  1 , Judith I Tsui  2 , John D Scott  3 , Julia C Dombrowski  4 , Sara N Glick  4
Affiliations

Age and gender-specific hepatitis C continuum of care and predictors of direct acting antiviral treatment among persons who inject drugs in Seattle, Washington

Maria A Corcorran et al. Drug Alcohol Depend. .

Abstract

Background: Direct acting antivirals (DAAs) have revolutionized management of hepatitis C virus (HCV), but treatment uptake remains low among persons who inject drugs (PWID). We report the continuum of care for HCV and describe predictors of treatment with DAAs among PWID in Seattle.

Methods: We analyzed data from the 2018 Seattle area National HIV Behavioral Surveillance (NHBS) survey of PWID. Persons ≥18 years of age who injected drugs in the past year and completed the core NHBS survey, a local survey supplement, and rapid HCV antibody testing were included. Among those who screened HCV antibody positive, we calculated proportions and 95 % confidence intervals for self-reported steps along the HCV care continuum. Multivariable logistic regression was used to calculate the adjusted odds (AOR) of having received DAA therapy.

Results: The sample included 533 PWID, 376 (71 %) of whom tested positive for antibodies to HCV. Among those who were HCV antibody positive, 94 % reported any prior HCV test, 81 % reported a prior confirmatory test, and 68 % reported a prior HCV diagnosis. Of those diagnosed, 26 % had undergone treatment and 18 % had been cured. In a multivariate model, being one year older (AOR 1.05 per year, 1.01-1.08) was predictive of DAA treatment, while homelessness (AOR 0.39, 0.19-0.80) and female gender (AOR 0.36, 0.16-0.78) were associated with a lower odds of DAA therapy.

Conclusions: Despite widespread HCV testing among PWID in Seattle, treatment uptake remains low in the DAA era. In particular, treatment of women, younger adults and persons living homeless is lagging behind.

Keywords: Continuum of care; DAA therapy; Hepatitis c; People who inject drugs.

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Figures

Figure 1.
Figure 1.. Hepatitis C Continuum of Care Among Seattle Area PWID, 2018 vs. 2015 NHBS Data
Data from the 2018 NHBS survey are depicted in the dark gray columns. Data from the 2015 NHBS survey are depicted in the light gray columns. Column 1: Total number of HCV antibody positive PWID (2018 n=376, 100%; 2015 n=338, 100%). Column 2: Proportion of HCV antibody positive PWID who report any prior test for HCV (2018 n=353, 94%; 2015 n=308, 91%). Column 3: Proportion of HCV antibody positive PWID who report a prior confirmatory test for HCV (2018 n=303, 81%; 2015 n/a). Column 4: Proportion of HCV antibody positive PWID who report a prior diagnosis of HCV (2018 n=254, 68%; 2015 n=247, 73%). Column 5: Proportion of HCV antibody positive PWID with a prior diagnosis of HCV who report treatment for HCV (2018 n=65, 26%; 2015 n=38, 16%). Column 6: Proportion of HCV antibody positive PWID with a prior diagnosis of HCV who report being cured of HCV (2018 n=46, 18%, 2015 n=14, 6%). Black error bars represent 95% confidence intervals for column percentages.
Figure 2.
Figure 2.. Hepatitis C Continuum of Care Among Seattle Area PWID by Age, 2018 NHBS
PWID 40 years of age and older are depicted in the dark gray columns. PWID less than 40 years of age are depicted in the light gray columns. Column 1: Total number of HCV antibody positive PWID ≥40 years of age (n= 220, 100%) and <40 years of age (n=156, 100%). Column 2: Proportion of HCV antibody positive PWID who report any prior test for HCV (≥40 years of age n=211, 96%; <40 years of age n=142, 91%). Column 3: Proportion of HCV antibody positive PWID who report a prior confirmatory test for HCV (≥40 years of age n=186, 85%; <40 years of age n=117, 75%). Column 4: Proportion of HCV antibody positive PWID who report a prior diagnosis of HCV (≥40 years of age n=159, 72%; ,40 years of age n=95, 61%). Column 5: Proportion of HCV antibody positive PWID with a prior diagnosis of HCV who report treatment for HCV (≥40 years of age n= 53, 33%; <40 years of age n=12, 13%). Column 6: Proportion of HCV antibody positive PWID with a prior diagnosis of HCV who report being cured of HCV (≥40 years of age n=40, 25%; <40 years of age n=6, 6%). Black error bars represent 95% confidence intervals for column percentages.
Figure 3.
Figure 3.. Hepatitis C Continuum of Care Among Seattle Area PWID by Gender, 2018 NHBS
Male PWID are depicted in the dark gray columns. Female PWID are depicted in the light gray columns. Column 1: Total number of HCV antibody positive male PWID (n= 228, 100%) and female PWID (n=145, 100%). Column 2: Proportion of HCV antibody positive PWID who report any prior test for HCV (males n=215, 94%; females n=135, 93%). Column 3: Proportion of HCV antibody positive PWID who report a prior confirmatory test for HCV (males n=185, 81%; females n=116, 80%). Column 4: Proportion of HCV antibody positive PWID who report a prior diagnosis of HCV (males n=160, 70%; females n=92, 63%). Column 5: Proportion of HCV antibody positive PWID with a prior diagnosis of HCV who report treatment for HCV (males n=50, 31%; females n=15, 16%). Column 6: Proportion of HCV antibody positive PWID with a prior diagnosis of HCV who report being cured of HCV (males n=35, 22%, females n=11, 12%). Black error bars represent 95% confidence intervals for column percentages.
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