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Liver Int. 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.

Author information

1
British Columbia Centre on Substance Use, Vancouver, BC, Canada.
2
Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
3
British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
4
Simon Fraser University, Burnaby, BC, Canada.

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

PMID:
30653809
PMCID:
PMC6640076
[Available on 2020-08-01]
DOI:
10.1111/liv.14043

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