Disparities in direct acting antivirals uptake in <scp>HIV</scp>‐hepatitis C co‐infected populations in Canada

Saeed, Sahar; Strumpf, Erin; Moodie, Erica E. M.; Young, Jim; Nitulescu, Roy; Cox, Joseph; Wong, Alexander; Walmsely, Sharon; Cooper, Curtis; Vachon, Marie‐Lousie; Martel-Laferrière, Valérie; Hull, Mark; Conway, Brian; Klein, Marina B.

doi:10.1002/jia2.25013

Cited by 57 publications

(46 citation statements)

References 51 publications

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“…Our study also found that non‐white PWID had lower odds of initiating DAA‐based therapies. These results are consistent with studies showing lower DAA treatment uptake rates among non‐whites in the US, as well as among Indigenous people in Canada and Australia . This is concerning given higher HCV prevalence and incidence rates among Indigenous populations relative to non‐indigenous populations .…”

Section: Discussionsupporting

confidence: 89%

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

Socías

Wood

et al. 2019

Liver International

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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 HCVpositive 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 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.

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Section: Discussionsupporting

confidence: 89%

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

Socías

Wood

et al. 2019

Liver International

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“…In the CCC (Canada), treatment uptake increased from 8 per 100 person years to 28 per 100 person years after the introduction of DAA therapies. [43]. This is consistent with increases in treatment uptake following the introduction of DAA therapies in predominantly HCV-monoinfected populations [44].…”

Section: Discussionsupporting

confidence: 78%

“…It is likely that more participants will be tested for HCV RNA at their next HIV clinic visit. n Includes DAA regimens including interferon, data collected up to July 2017 [43]. o Of those initiating DAA therapy prior to February (24 week therapy)/May 2015 (12 week therapy) [49].…”

Section: Discussionmentioning

confidence: 99%

Linkage and retention in HCV care for HIV‐infected populations: early data from the DAA era

et al. 2018

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IntroductionThere is currently no published data on the effectiveness of DAA treatment for elimination of HCV infection in HIV‐infected populations at a population level. However, a number of relevant studies and initiatives are emerging. This research aims to report cascade of care data for emerging HCV elimination initiatives and studies that are currently being evaluated in HIV/HCV co‐infected populations in the context of implementation science theory.Methods HCV elimination initiatives and studies in HIV co‐infected populations that are currently underway were identified. Context, intervention characteristics and cascade of care data were synthesized in the context of implementation science frameworks.ResultsSeven HCV elimination initiatives and studies were identified in HIV co‐infected populations, mainly operating in high‐income countries. Four were focused mainly on HCV elimination in HIV‐infected gay and bisexual men (GBM), and three included a combination of people who inject drugs (PWID), GBM and other HIV‐infected populations. None were evaluating treatment delivery in incarcerated populations. Overall, HCV RNA was detected in 4894 HIV‐infected participants (range within studies: 297 to 994): 48% of these initiated HCV treatment (range: 21% to 85%; within studies from a period where DAAs were broadly available the total is 57%, range: 36% to 74%). Among studies with treatment completion data, 96% of 1109 initiating treatment completed treatment (range: 94% to 99%). Among those who could be assessed for sustained virological response at 12 weeks (SVR12), 1631 of 1757 attained SVR12 (93%, range: 86% to 98%).ConclusionsEarly results from emerging research on HCV elimination in HIV‐infected populations suggest that HCV treatment uptake is higher than reported levels prior to DAA treatment availability, but approximately half of patients remain untreated. These results are among diagnosed populations and additional effort is required to increase diagnosis rates. Among those who have initiated treatment, completion and SVR rates are promising. More data are required in order to evaluate the effectiveness of these elimination programmes in the long term, assess which intervention components are effective, and whether they need to be tailored to particular population groups.

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“…The Spanish National Strategy for HCV treatment does not restrict DAA uptake in patients with recent drug or alcohol dependence , which is also in accordance with international clinical guidelines . Substance abuse has been identified as a major barrier to HCV treatment uptake in other settings . In this context, in a study conducted in Canada which included 1699 HIV/HCV‐coinfected patients, abuse of substances such alcohol [hazard ratio (HR) 0.74; 95% CI 0.58, 0.94] and active PWID (HR 0.60; 95% CI 0.38, 0.94) were associated with a lower rate of HCV treatment uptake.…”

Section: Discussionmentioning

confidence: 99%

Parenteral drug use as the main barrier to hepatitis C treatment uptake in HIV‐infected patients

et al. 2019

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ObjectivesOur objective was to identify patient factors associated with being untreated for hepatitis C virus (HCV) infection in HIV-coinfected patients. MethodsA prospective longitudinal study was carried out. HIV-infected patients with active chronic HCV infection included in the HERACLES cohort (NCT02511496) constituted the study population. The main study outcome was receipt of HCV direct-acting antiviral (DAA) treatment from 1 May 2015 to 1 May 2017. The population was divided into patients who were receiving HCV treatment during follow-up and those who were not. ResultsOf the 15 556 HIV-infected patients in care, 3075 (19.7%) presented with chronic HCV infection and constituted the study population. At the end of the follow-up, 1957 patients initiated HCV therapy (63.6%). Age < 50 years, absence of or minimal liver fibrosis, being treatment-na€ ıve, HCV genotype 3 infection, being in the category of people who inject drugs using opioid substitutive therapy (OST-PWID), and being in the category of recent PWID were identified as significant independent risk factors associated with low odds of DAA implementation. When a multivariate analysis was performed including only the PWID population, both OST-PWID [odds ratio (OR) 0.552; 95% confidence interval (CI) 0.409-0.746) and recent PWID (OR 0.019; 95% CI 0.004-0.087) were identified as independent factors associated with low odds of treatment implementation.We identified factors, which did not include prioritization of a DAA uptake strategy, that limited access to HCV therapy. The low treatment uptake in several populations seriously jeopardizes the elimination of HCV infection in the coming years.

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Disparities in direct acting antivirals uptake in HIV‐hepatitis C co‐infected populations in Canada

Cited by 57 publications

References 51 publications

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

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

Linkage and retention in HCV care for HIV‐infected populations: early data from the DAA era

Parenteral drug use as the main barrier to hepatitis C treatment uptake in HIV‐infected patients

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