Decreasing Hepatitis C Incidence Among a Population With Repeated Tests: British Columbia, Canada, 1993–2011

Kuo, Margot; Janjua, Naveed Z.; Burchell, Ann; Buxton, Jane A.; Krajden, Mel; Gilbert, Mark

doi:10.2105/ajph.2015.302591

Cited by 17 publications

(12 citation statements)

References 22 publications

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“…HBV co-infection and mental health problems were significantly associated with increased odds of new infection but decreased odds of prevalent HCV infection, while ORs for illicit drug use compared to no drug use among new infections (AOR = 21) were four times than those for prevalent HCV infection (AOR = 5.0). ORs for prevalent HCV infection were highest for birth cohort 1945-64 and declined thereafter, while among new infections, ORs were highest for those born later, consistent with an earlier analysis demonstrating a higher HCV incidence rate in younger birth cohorts [ 25 ]. Demographic characteristics and risk factors for prevalent HCV were also consistent with recent data from the United States and Canada [ 8 , 20 ].…”

Section: Discussionsupporting

confidence: 83%

Twin epidemics of new and prevalent hepatitis C infections in Canada: BC Hepatitis Testers Cohort

Janjua

Kuo

et al. 2016

BMC Infect Dis

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BackgroundWe characterized the twin epidemics of new and prevalent hepatitis C virus (HCV) infections in British Columbia, Canada to inform prevention, care and treatment programs.MethodsThe BC Hepatitis Testers Cohort (BC-HTC) includes individuals tested for HCV, HIV or reported as a case of HBV, HCV, HIV or active TB between 1990–2013 linked with data on their medical visits, hospitalizations, cancers, prescription drugs and mortality. Prevalent infection was defined as being anti-HCV positive at first test. Those with a negative test followed by a positive test were considered seroconverters or new infections.ResultsOf 1,132,855 individuals tested for HCV, 64,634 (5.8 %) were positive and an additional 3092 cases tested positive elsewhere for a total of 67,726. Of 55,781 HCV positive individuals alive at the end of 2013, 7064 were seroconverters while 48,717 had prevalent infection at diagnosis. The HCV positivity rate (11.2 %) was highest in birth cohort 1945–1964 which declined over time. New infections were more likely to be male, 15–34 years of age (born 1965-1984), HIV- or HBV-coinfected, socioeconomically disadvantaged, have problematic drug and alcohol use and a mental health illness. The profile was similar for individuals with prevalent infection, except for lower odds of HBV-coinfection, major mental health diagnoses and birth cohort >1975.ConclusionsThe HCV positivity rate is highest in birth cohort 1945–1964 which represents most prevalent infections. New infections occur in younger birth cohorts who are commonly coinfected with HIV and/or HBV, socioeconomically marginalized, and living with mental illness and addictions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1683-z) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 83%

Twin epidemics of new and prevalent hepatitis C infections in Canada: BC Hepatitis Testers Cohort

Janjua

Kuo

et al. 2016

BMC Infect Dis

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“…In addition, as people age, their drug use pattern also changes. In our other analyses, we have seen that incidence of HCV was much lower in older birth cohorts compared to those born after 1975 [ 32 ]. Another phenomenon could be aging of the population who inject with fewer younger people initiating injecting.…”

Section: Discussionmentioning

confidence: 99%

A syndemic approach to assess the effect of substance use and social disparities on the evolution of HIV/HCV infections in British Columbia

et al. 2017

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BackgroundCo-occurrence of social conditions and infections may affect HIV/HCV disease risk and progression. We examined the changes in relationship of these social conditions and infections on HIV and hepatitis C virus (HCV) infections over time in British Columbia during 1990–2013.MethodsThe BC Hepatitis Testers Cohort (BC-HTC) includes ~1.5 million individuals tested for HIV or HCV, or reported as a case of HCV, HIV, HBV, or tuberculosis linked to administrative healthcare databases. We classified HCV and HIV infection status into five combinations: HIV-/HCV-, HIV+monoinfected, HIV-/HCV+seroconverters, HIV-/HCV+prevalent, and HIV+/HCV+.ResultsOf 1.37 million eligible individuals, 4.1% were HIV-/HCV+prevalent, 0.5% HIV+monoinfected, 0.3% HIV+/HCV+ co-infected and 0.5% HIV-/HCV+seroconverters. Overall, HIV+monoinfected individuals lived in urban areas (92%), had low injection drug use (IDU) (4%), problematic alcohol use (4%) and were materially more privileged than other groups. HIV+/HCV+ co-infected and HIV-/HCV+seroconverters were materially most deprived (37%, 32%), had higher IDU (28%, 49%), problematic alcohol use (14%, 17%) and major mental illnesses (12%, 21%). IDU, opioid substitution therapy, and material deprivation increased in HIV-/HCV+seroconverters over time. In multivariable multinomial regression models, over time, the odds of IDU declined among HIV-/HCV+prevalent and HIV+monoinfected individuals but not in HIV-/HCV+seroconverters. Declines in odds of problematic alcohol use were observed in HIV-/HCV+seroconverters and coinfected individuals over time.ConclusionsThese results highlight need for designing prevention, care and support services for HIV and HCV infected populations based on the evolving syndemics of infections and social conditions which vary across groups.

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“…Therefore, this study may overestimate the number of undiagnosed people in BC, and the observed decline in prevalence may be larger than we estimate here. Declining HCV prevalence is not only driven by increased treatment and cure achieved by DAAs, as new/incident HCV cases have fallen in BC over the last decade, as have people who test positive the first time that they are tested, and mortality among people affected by HCV is significantly higher, compared to those who have tested negative for HCV. There may also be some bias in the classification of history of mental illness and substance use.…”

Section: Discussionmentioning

confidence: 99%

“…Hepatitis C virus (HCV) infection remains a leading global cause of morbidity and mortality, despite declining incidence of HCV infection in many settings. Morbidity and mortality related to chronic HCV infection continues to increase, driven by large populations of people living with HCV who acquired the infection decades ago.…”

Section: Introductionmentioning

confidence: 99%

The population level care cascade for hepatitis C in British Columbia, Canada as of 2018: Impact of direct acting antivirals

Bartlett

Chapinal

et al. 2019

Liver International

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Background: Population-level monitoring of hepatitis C virus (HCV) infected people across cascades of care identifies gaps in access and engagement in care and treatment. We characterized the population-level care cascade for HCV in British Columbia (BC), Canada before and after introduction of Direct Acting Antiviral (DAA) treatment. Methods: BC Hepatitis Testers Cohort (BC-HTC) includes 1.7 million individuals tested for HCV, HIV, reported cases of hepatitis B, and active tuberculosis in BC from 1990 to 2018 linked to medical visits, hospitalizations, cancers, prescription drugs and mortality data. We defined six HCV care cascade stages: (a) antibody diagnosed; (b) RNA tested; (c) RNA positive; (d) genotyped; (e) initiated treatment; and (f) achieved sustained virologic response (SVR). Results:We estimated 61 127 people were HCV antibody positive in BC in 2018 (undiagnosed: 7686, 13%; diagnosed: 53 441, 87%). Of those diagnosed, 83% (44 507) had HCV RNA testing, and of those RNA positive, 90% (28 716) were genotyped. Of those genotyped, 61% (17 441) received therapy, with 90% (15 672) reaching SVR.Individuals from older birth cohorts had lower progression to HCV RNA testing.While people who currently inject drugs had the highest proportional progression to RNA testing, this group had the lowest proportional treatment uptake. Conclusions: Although gaps in HCV RNA and genotype testing after antibody diagnosis exist, the largest gap in the care cascade is treatment initiation, despite introduction of DAA treatment and removal of treatment eligibility restrictions. Further interventions are required to ensure testing and treatment is equitably accessible in BC.

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Decreasing Hepatitis C Incidence Among a Population With Repeated Tests: British Columbia, Canada, 1993–2011

Abstract: Addictions treatment, harm reduction, prevention education, and novel initiatives to remove barriers in health infrastructure need to be intensified for those who inject drugs, particularly men and younger persons.

Cited by 17 publications

References 22 publications

Twin epidemics of new and prevalent hepatitis C infections in Canada: BC Hepatitis Testers Cohort

Twin epidemics of new and prevalent hepatitis C infections in Canada: BC Hepatitis Testers Cohort

A syndemic approach to assess the effect of substance use and social disparities on the evolution of HIV/HCV infections in British Columbia

The population level care cascade for hepatitis C in British Columbia, Canada as of 2018: Impact of direct acting antivirals

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