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

Socías, M. Eugenia; Ti, Lianping; Wood, Evan; Nosova, Ekaterina; Hull, Mark; Hayashi, Kanna; DeBeck, Kora; Milloy, M‐J

doi:10.1111/liv.14043

Cited by 68 publications

(78 citation statements)

References 43 publications

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“…Finally, when we restricted our analyses to people with substance use disorders, those who were middle-aged were less likely to receive DAA, although these individuals were equally likely to achieve cure. Others in similar settings have also noted this disparity [63]. This finding is of concern given that DAA therapy is reimbursed by our provincial formulary for nearly all patients and that the average age of people with HCV who use drugs in Canada is in the mid to late forties range [63,64].…”

Section: Discussionmentioning

confidence: 94%

HCV-infected individuals have higher prevalence of comorbidity and multimorbidity: a retrospective cohort study

et al. 2019

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Background: Almost 1% of Canadians are hepatitis C (HCV)-infected. The liver-specific complications of HCV are established but the extra-hepatic comorbidity, multimorbidity, and its relationship with HCV treatment, is less well known. We describe the morbidity burden for people with HCV and the relationship between multimorbidity and HCV treatment uptake and cure in the pre-and post-direct acting antiviral (DAA) era. Methods: We linked adults with HCV at The Ottawa Hospital Viral Hepatitis Program as of April 1, 2017 to provincial health administrative data and matched on age and sex to 5 Ottawa-area residents for comparison. We used validated algorithms to identify the prevalence of mental and physical health comorbidities, as well as multimorbidity (2+ comorbidities). We calculated direct age-and sex-standardized rates of comorbidity and comparisons were made by interferon-based and interferon-free, DAA HCV treatments. Results: The mean age of the study population was 54.5 years (SD 11.4), 65% were male. Among those with HCV, 4% were HIV co-infected, 26% had liver cirrhosis, 47% received DAA treatment, and 57% were cured of HCV. After accounting for age and sex differences, the HCV group had greater multimorbidity (prevalence ratio (PR) 1.38, 95% confidence interval (CI) 1.20 to 1.58) and physical-mental health multimorbidity (PR 2.71, 95% CI 2.29-3.20) compared to the general population. Specifically, prevalence ratios for people with HCV were significantly higher for diabetes, renal failure, cancer, asthma, chronic obstructive pulmonary disease, substance use disorder, mood and anxiety disorders and liver failure. HCV treatment and cure were not associated with multimorbidity, but treatment prevalence was significantly lower among middle-aged individuals with substance use disorders despite no differences in prevalence of cure among those treated. Conclusion: People with HCV have a higher prevalence of comorbidity and multimorbidity compared to the general population. While HCV treatment was not associated with multimorbidity, people with substance use disorder were less likely to be treated. Our results point to the need for integrated, comprehensive models of care delivery for people with HCV.

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Section: Discussionmentioning

confidence: 94%

HCV-infected individuals have higher prevalence of comorbidity and multimorbidity: a retrospective cohort study

et al. 2019

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“…Others in similar settings have also noted this disparity. [49] This finding is of concern given that DAA therapy is reimbursed by our provincial formulary for nearly all patients and that the average age of people with HCV who use drugs in Canada is in the mid to late forties range. [49,50] It is critical to develop policies and strategies that facilitate DAA uptake and completion in those facing barriers to treatment.…”

Section: Discussionmentioning

confidence: 99%

“…[49] This finding is of concern given that DAA therapy is reimbursed by our provincial formulary for nearly all patients and that the average age of people with HCV who use drugs in Canada is in the mid to late forties range. [49,50] It is critical to develop policies and strategies that facilitate DAA uptake and completion in those facing barriers to treatment. [51,52] A strength of our study is that we used a combination of rich data from a diverse cohort of people living with HCV in a broad geographic region combined with robust population-level data for comorbidity ascertainment.…”

Section: Discussionmentioning

confidence: 99%

HCV-Infected Individuals have Higher Prevalence of Comorbidity and Multimorbidity: A retrospective cohort study

Cooper

Galanakis

Donelle

et al. 2019

Preprint

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Background Almost 1% of Canadians are hepatitis C (HCV)-infected. The liver-specific complications of HCV are established but the extra-hepatic comorbidity, multimorbidity, and its relationship with HCV treatment, is less well known. We describe the morbidity burden for people with HCV and the relationship between multimorbidity and HCV treatment in the pre- and post-direct acting antiviral (DAA) era. Methods We linked adults with HCV at The Ottawa Hospital Viral Hepatitis Program as of April 1, 2017 to provincial health administrative data and matched on age and sex to 5 Ottawa-area residents for comparison. We used validated algorithms to identify the prevalence of mental and physical health comorbidities, as well as multimorbidity (2+ comorbidities). We calculated direct age- and sex-standardized rates of comorbidity and comparisons were made by interferon-based and DAA HCV treatments. Results The mean age of the study population was 54.5 years (SD 11.4), 65% were male. Among those with HCV, 4% were HIV co-infected, 26% had liver cirrhosis, 47% received DAA treatment, and 57% were cured of HCV. After accounting for age and sex differences, the HCV group had greater multimorbidity (prevalence ratio (PR) 1.38, 95% confidence interval (CI) 1.20 to 1.58) and physical-mental health multimorbidity (PR 2.71, 95% CI 2.29 – 3.20) compared to the general population. Specifically, prevalence ratios for people with HCV were significantly higher for diabetes, renal failure, cancer, asthma, chronic obstructive pulmonary disease, substance use disorder, mood and anxiety disorders and liver failure. HCV treatment and cure were not associated with multimorbidity, but treatment prevalence was significantly lower among middle-aged individuals with substance use disorders despite no differences in prevalence of cure among those treated. Conclusion People with HCV have a higher prevalence of comorbidity and multimorbidity compared to the general population. While HCV treatment was not associated with multimorbidity, people with substance use disorder were less likely to be treated. Our results point to the need for integrated, comprehensive models of care delivery for people with HCV.

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“…Although PWID remain a core driver of the HCV epidemic, with high HCV prevalence and the potential to sustain ongoing transmission in many parts of the world, HCV treatment uptake has remained low among this group. Recent data from the DAA era suggest that less than 20% of HCV‐infected PWID in different global settings have ever received HCV treatment 17‐19 . To achieve HCV elimination goals, HCV treatment uptake among PWID must increase 20 .…”

Section: Introductionmentioning

confidence: 99%

Network‐based recruitment of people who inject drugs for hepatitis C testing and linkage to care

Falade‐Nwulia

Ward

McCormick

et al. 2020

Journal of Viral Hepatitis

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Although oral direct‐acting agent (DAA) therapies have the potential to reduce the burden of hepatitis C virus (HCV) infection, treatment uptake remains low, particularly among people who inject drugs (PWID). This study examined the feasibility of an innovative peer‐based recruitment strategy to engage PWID in HCV testing and treatment. We interviewed an initial set of HCV antibody‐positive PWID as ‘primary indexes’ to gather demographic, drug use, health information and drug network characteristics. Primary indexes were then briefly educated on HCV and its treatment and encouraged to recruit their injection drug ‘network members’ for HCV testing and linkage to care. Eligible network members were enrolled as ‘secondary indexes’ and completed the same index study procedures. In sum, 17 of 36 primary indexes initiated the recruitment of 64 network members who were HCV antibody positive and eligible to become indexes. In multivariable analysis, successful recruitment of at least one network member was positively associated with prior HCV treatment (OR 2.80; CI [1.01, 7.72]), daily or more injection drug use (OR 2.38; CI [1.04, 5.47]), and a higher number of injection drug network members (OR 1.20; CI [1.01, 1.42]). Among the 69 participants with chronic HCV not previously linked to HCV care at enrolment, 91% (n = 63) completed a linkage to HCV care appointment, 45% (n = 31) scheduled an appointment with an HCV provider, and 20% (n = 14) initiated HCV therapy. These findings suggest a potential benefit for peer‐driven, network‐based interventions focused on HCV treatment‐experienced PWID as a mechanism to increase HCV linkage to care.

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

Cited by 68 publications

References 43 publications

HCV-infected individuals have higher prevalence of comorbidity and multimorbidity: a retrospective cohort study

HCV-infected individuals have higher prevalence of comorbidity and multimorbidity: a retrospective cohort study

HCV-Infected Individuals have Higher Prevalence of Comorbidity and Multimorbidity: A retrospective cohort study

Network‐based recruitment of people who inject drugs for hepatitis C testing and linkage to care

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