TY - JOUR
T1 - Eliminating hepatitis C in Australia
T2 - a novel model of hepatitis C testing and treatment for people who inject drugs at a medically supervised injecting facility
AU - MacIsaac, Michael B.
AU - Whitton, Bradley
AU - Hubble, Adrian
AU - Cogger, Shelley
AU - Penn, Matthew
AU - Weeks, Anthony
AU - Elmore, Kasey
AU - Pemberton, David
AU - Anderson, Jenine
AU - Howard, Rebecca
AU - McKeever, Una
AU - Papaluca, Timothy
AU - Hellard, Margaret E.
AU - Stoove, Mark
AU - Wilson, David
AU - Pedrana, Alisa
AU - Doyle, Joseph
AU - Clark, Nico
AU - Holmes, Jacinta
AU - Thompson, Alexander J.
N1 - Funding Information:
Alexander Thompson received funding from the National Health and Medical Research Council (NHMRC; Practitioner Fellowship Grant 1142976). This investigation was supported by an NHMRC Program Grant (1132902) and an NHMRC Partnership Grant (1116161). Jacinta Holmes is funded by a University of Melbourne CR Roper Fellowship and an NHMRC program grant.
Publisher Copyright:
© 2023 The Authors. Medical Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of AMPCo Pty Ltd.
PY - 2023/4
Y1 - 2023/4
N2 - Objective: To evaluate the feasibility of testing and treating people who inject drugs at a supervised injecting facility for hepatitis C virus (HCV) infection. Design: Retrospective cohort study. Setting, participants: People who inject drugs who attended the Melbourne supervised injecting facility, 30 June 2018 – 30 June 2020. Main outcome measures: Proportion of people tested for hepatitis C; proportions of people positive for anti-HCV antibody and HCV RNA, and of eligible people prescribed direct-acting antiviral (DAA) treatment; sustained virological response twelve weeks or more after treatment completion. Results: Of 4649 people who attended the supervised injecting facility during 2018–20, 321 were tested for hepatitis C (7%); 279 were anti-HCV antibody-positive (87%), of whom 143 (51%) were also HCV RNA-positive. Sixty-four of 321 had previously been treated for hepatitis C (20%), 21 had clinically identified cirrhosis (7%), eight had hepatitis B infections (2%), and four had human immunodeficiency virus infections (1%). In multivariate analyses, people tested for hepatitis C were more likely than untested clients to report psychiatric illness (adjusted odds ratio [aOR], 9.65; 95% confidence interval [CI], 7.26–12.8), not have a fixed address (aOR, 1.59; 95% CI, 1.18–2.14), and to report significant alcohol use (aOR, 1.57; 95% CI, 1.06–2.32). The median number of injecting facility visits was larger for those tested for hepatitis C (101; interquartile range [IQR], 31–236) than for those not tested (20; IQR, 3–90). DAA treatment was prescribed for 126 of 143 HCV RNA-positive clients (88%); 41 of 54 with complete follow-up data were cured (76%). Conclusions: People who attend supervised injecting facilities can be tested and treated for hepatitis C on site. Models that provide streamlined, convenient hepatitis C care promote engagement with treatment in a group in which the prevalence of hepatitis C is high.
AB - Objective: To evaluate the feasibility of testing and treating people who inject drugs at a supervised injecting facility for hepatitis C virus (HCV) infection. Design: Retrospective cohort study. Setting, participants: People who inject drugs who attended the Melbourne supervised injecting facility, 30 June 2018 – 30 June 2020. Main outcome measures: Proportion of people tested for hepatitis C; proportions of people positive for anti-HCV antibody and HCV RNA, and of eligible people prescribed direct-acting antiviral (DAA) treatment; sustained virological response twelve weeks or more after treatment completion. Results: Of 4649 people who attended the supervised injecting facility during 2018–20, 321 were tested for hepatitis C (7%); 279 were anti-HCV antibody-positive (87%), of whom 143 (51%) were also HCV RNA-positive. Sixty-four of 321 had previously been treated for hepatitis C (20%), 21 had clinically identified cirrhosis (7%), eight had hepatitis B infections (2%), and four had human immunodeficiency virus infections (1%). In multivariate analyses, people tested for hepatitis C were more likely than untested clients to report psychiatric illness (adjusted odds ratio [aOR], 9.65; 95% confidence interval [CI], 7.26–12.8), not have a fixed address (aOR, 1.59; 95% CI, 1.18–2.14), and to report significant alcohol use (aOR, 1.57; 95% CI, 1.06–2.32). The median number of injecting facility visits was larger for those tested for hepatitis C (101; interquartile range [IQR], 31–236) than for those not tested (20; IQR, 3–90). DAA treatment was prescribed for 126 of 143 HCV RNA-positive clients (88%); 41 of 54 with complete follow-up data were cured (76%). Conclusions: People who attend supervised injecting facilities can be tested and treated for hepatitis C on site. Models that provide streamlined, convenient hepatitis C care promote engagement with treatment in a group in which the prevalence of hepatitis C is high.
KW - Hepatitis C
KW - Hepatitis, viral
KW - Policy, drugs and alcohol
KW - World Health Organization
UR - http://www.scopus.com/inward/record.url?scp=85149881127&partnerID=8YFLogxK
U2 - 10.5694/mja2.51885
DO - 10.5694/mja2.51885
M3 - Article
C2 - 36919230
AN - SCOPUS:85149881127
SN - 0025-729X
VL - 218
SP - 256
EP - 261
JO - The Medical Journal of Australia
JF - The Medical Journal of Australia
IS - 6
ER -
