The Population Level Cascade of Care for Hepatitis C in British Columbia, Canada: The BC Hepatitis Testers Cohort (BC-HTC)

Janjua, Naveed Z.; Kuo, Margot; Yu, Amanda; Alvarez, Maria; Wong, Stanley; Cook, Darrel; Wong, Jason; Grebely, Jason; Butt, Zahid A; Samji, Hasina; Ramji, Alnoor; Tyndall, Mark W.; Krajden, Mel

doi:10.1016/j.ebiom.2016.08.035

Cited by 99 publications

(97 citation statements)

References 27 publications

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“…However, the gap between near 100% curative treatments and viral elimination is immense if only a small segment of the population initiates treatment . HCV treatment cascades among HCV mono‐infected individuals highlight the need for better screening, diagnosis and linkage to care to ultimately cure HCV . HIV‐HCV coinfected populations are generally well identified and already engaged in HIV care therefore easier to reach compared to HCV mono‐infected populations.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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BackgroundDirect acting antivirals (DAAs) have revolutionized hepatitis C (HCV) treatment with >90% cure rates even in real‐world studies, giving hope that HCV can be eliminated. However, for DAAs to have a population‐level impact on the burden of HCV disease, treatment uptake needs to be expanded. We investigated temporal trends in HCV treatment uptake and evaluated factors associated with second‐generation DAA initiation and efficacy among key HIV‐HCV co‐infected populations in Canada.MethodsThe Canadian HIV‐HCV Co‐Infection Cohort Study prospectively follows 1699 participants from 18 centres. Among HCV RNA+ participants, we determined the incidence of HCV treatment initiation per year overall and by key populations between 2007 and 2015. Key populations were based on World Health Organization (WHO) guidelines including: people who actively inject drugs (PWID) (reporting injection drug use, last 6 months); Indigenous people; women and men who have sex with men (MSM). Multivariate Cox models were used to estimate adjusted hazard ratios (aHR) and 2‐year probability of initiating second‐generation DAAs for each of the key populations.ResultsOverall, HCV treatment initiation rates increased from 8 (95% CI, 6–11) /100 person‐years in 2013 to 28 (95% CI, 23–33) /100 person‐years in 2015. Among 911 HCV RNA + participants, there were 202 second‐generation DAA initiations (93% with interferon‐free regimens). After adjustment (aHR, 95% CI), active PWID (0.60, 0.38–0.94 compared to people not injecting drugs) and more generally, people with lower income (<$18 000 CAD/year) (0.50, 0.35, 0.71) were less likely to initiate treatment. Conversely, MSM were more likely to initiate 1.95 (1.33, 2.86) compared to heterosexual men. In our cohort, the population profile with the lowest 2‐year probability of initiating DAAs was Indigenous, women who inject drugs (5%, 95% CI 3–8%). Not having any of these risk factors resulted in a 35% (95% CI 32–38%) probability of initiating DAA treatment. Sustained virologic response (SVR) rates were >82% in all key populations.ConclusionWhile treatment uptake has increased with the availability of second‐generation DAAs, marginalized populations, already engaged in care, are still failing to access treatment. Targeted strategies to address barriers are needed to avoid further health inequities and to maximize the public health impact of DAAs.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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“…The HIV co‐infected population are more likely to be engaged in medical care than the HCV‐mono‐infected population given increasingly high levels of HIV ART uptake globally . Theoretically, this provides an opportunity for broad coverage of HCV treatment in this population, particularly given that DAA treatment regimens are similar in co‐infected and mono‐infected populations with equivalent treatment outcomes . However, it is important to note that despite increases in ART coverage, coverage in the key at‐risk populations still lags behind in some contexts possibly due to lower levels of engagement in medical care and discriminatory prescribing practices .…”

Section: Introductionmentioning

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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“…In North America, large numbers of people acquired the virus decades ago and are now increasingly being diagnosed with serious liver‐related illnesses including decompensated cirrhosis and hepatocellular carcinoma (HCC) . Interferon‐based treatments have been available since early 2000, but due to low uptake and effectiveness (~50% cured), these treatments have resulted in limited population‐level impact . As a result, HCV‐associated liver‐related morbidity and mortality have been increasing across the world …”

Section: Introductionmentioning

confidence: 99%

“…Although overall treatment rates were low in the interferon‐based era (<15%), rates were especially low for certain population groups including people who inject drugs (PWIDs) and people co‐infected with HIV . Some of the barriers to treatment included higher toxicity and perceived lack of compliance among PWIDs and HIV‐co‐infected individuals …”

Section: Introductionmentioning

confidence: 99%

Shift in disparities in hepatitis C treatment from interferon to DAA era: A population‐based cohort study

Janjua

Islam

Wong

et al. 2017

Journal of Viral Hepatitis

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We evaluated the shift in the characteristics of people who received interferon-based hepatitis C virus (HCV) treatments and those who received recently introduced direct-acting antivirals (DAAs) in British Columbia (BC), Canada. The BC Hepatitis Testers Cohort includes 1.5 million individuals tested for HCV or HIV, or reported cases of hepatitis B and active tuberculosis in BC from 1990 to 2013 linked to medical visits, hospitalization, cancer, prescription drugs and mortality data. This analysis included all patients who filled at least one prescription for HCV treatment until 31 July 2015. HCV treatments were classified as older interferon-based treatments including pegylated interferon/ribavirin (PegIFN/RBV) with/without boceprevir or telaprevir, DAAs with RBV or PegIFN/RBV, and newer interferon-free DAAs. Of 11 886 people treated for HCV between 2000 and 2015, 1164 (9.8%) received interferon-free DAAs (ledipasvir/sofosbuvir: n=1075; 92.4%), while 452 (3.8%) received a combination of DAAs and RBV or PegIFN/RBV. Compared to those receiving interferon-based treatment, people with HIV co-infection (adjusted odds ratio [aOR]: 2.96, 95% CI: 2.31-3.81), cirrhosis (aOR: 1.77, 95% CI: 1.45-2.15), decompensated cirrhosis (aOR: 1.72, 95% CI: 1.31-2.28), diabetes (aOR: 1.30, 95% CI: 1.10-1.54), a history of injection drug use (aOR: 1.34, 95% CI: 1.09-1.65) and opioid substitution therapy (aOR: 1.30, 95% CI: 1.01-1.67) were more likely to receive interferon-free DAAs. Socio-economically marginalized individuals were significantly less likely (most deprived vs most privileged: aOR: 0.71, 95% CI: 0.58-0.87) to receive DAAs. In conclusion, there is a shift in prescription of new HCV treatments to previously excluded groups (eg HIV-co-infected), although gaps remain for the socio-economically marginalized populations.

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The Population Level Cascade of Care for Hepatitis C in British Columbia, Canada: The BC Hepatitis Testers Cohort (BC-HTC)

Cited by 99 publications

References 27 publications

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

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

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

Shift in disparities in hepatitis C treatment from interferon to DAA era: A population‐based cohort study

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