@article{65e1891a526b48e7a549c92c947bf855,
title = "Hepatitis C treatment outcomes for Australian First Nations Peoples: equivalent SVR rate but higher rates of loss to follow-up",
abstract = "Background: First Nations Peoples of Australia are disproportionally affected by hepatitis C (HCV) infection. Through a prospective study we evaluated the outcome of direct-acting antiviral (DAA) therapy among First Nations Peoples with HCV infection. Methods: Adults who initiated DAA therapy at one of 26 hospitals across Australia, 2016–2019 were included in the study. Clinical data were obtained from medical records and the Pharmaceutical and Medicare Benefits Schemes. Outcomes included sustained virologic response (SVR) and loss to follow-up (LTFU). A multivariable analysis assessed factors associated with LTFU. Results: Compared to non-Indigenous Australians (n = 3206), First Nations Peoples (n = 89) were younger (p < 0.001), morel likely to reside in most disadvantaged (p = 0.002) and in regional/remote areas (p < 0.001), and had similar liver disease severity. Medicines for mental health conditions were most commonly dispensed among First Nations Peoples (55.2% vs. 42.8%; p = 0.022). Of 2910 patients with follow-up data, both groups had high SVR rates (95.3% of First Nations Peoples vs. 93.2% of non-Indigenous patients; p = 0.51) and {\textquoteleft}good{\textquoteright} adherence (90.0% vs. 86.9%, respectively; p = 0.43). However, 28.1% of First Nations Peoples were LTFU vs. 11.2% of non-Indigenous patients (p < 0.001). Among First Nations Peoples, younger age (adj-OR = 0.93, 95% CI 0.87–0.99) and treatment initiation in 2018–2019 vs. 2016 (adj-OR = 5.14, 95% CI 1.23–21.36) predicted LTFU, while higher fibrosis score was associated with better engagement in HCV care (adj-OR = 0.71, 95% CI 0.50–0.99). Conclusions: Our data showed that First Nations Peoples have an equivalent HCV cure rate, but higher rates of LTFU. Better strategies to increase engagement of First Nations Peoples with HCV care are needed.",
keywords = "Data linkage, Liver fibrosis, Loss to follow-up, Sustained viral response",
author = "Clark, {Paul J.} and Valery, {Patricia C.} and James Ward and Strasser, {Simone I.} and Martin Weltman and Alexander Thompson and Levy, {Miriam T.} and Barbara Leggett and Amany Zekry and Julian Rong and Peter Angus and Jacob George and Steven Bollipo and Bruce McGarity and William Sievert and Gerry Macquillan and Edmund Tse and Amanda Nicoll and Amanda Wade and Geoff Chu and Damian Harding and Wendy Cheng and Geoff Farrell and Roberts, {Stuart K.}",
note = "Funding Information: Project governance was overseen the Project Steering Committee, via the GESA Liver Clinical Research Network. QIMR Berghofer was the administering institution. We thank the patients for participating in the study. We also thank the research personnel, including Karen Martin (QIMR Berghofer) for her support coordinating the study, Therese Lawton (QIMR Berghofer) for data management, and the research nurses from study sites for recruitment and data collection. We thank Kelly Hayward for assistance with reviewing the coding of medication data obtained from PBS data for the calculation of the RxRisk-V. PJC is a Hepatologist at the Princess Alexandra and Mater Hospitals, and Inala Indigenous Health. PCV is researcher at QIMR Berghofer Medical Research Institute, and Professor at the Faculty of Medicine, The University of Queensland. JW is a Pitjantjatjara and Nukunu man, an infectious diseases epidemiologist, a national leader in Aboriginal and Torres Strait Islander research, and the Director of UQ Poche Centre for Indigenous Health, The University of Queensland. SIS is a Hepatologist at the Royal Prince Alfred Hospital. MW is a Hepatologist at the Nepean Hospital. AT is a Hepatologist, St Vincent{\textquoteright}s Hospital. MTL is a Hepatologist at the Liverpool Hospital. BL is a Gastroenterologist at the Royal Brisbane and Women{\textquoteright}s Hospital. AZ is a Hepatologist at St George Hospital. JR is a Gastroenterologist at Latrobe Regional Hospital. PA is a Hepatologist at Austin Hospital. JG is a Hepatologist at Westmead Hospital. SB is a Gastroenterologist at John Hunter Hospital.BM is a Hepatologist at Bathurst Hospital. WS is a Hepatologist at Monash Health. GM is a Hepatologist at Sir Charles Gairdner Hospital. ET is a Hepatologist at the Royal Adelaide Hospital. AN is a Gastroenterologist at Eastern Health Box Hill. AW is a Hepatologist at University Hospital Geelong. GC is a Gastroenterologist at Orange Hospital. DH is a Hepatologist at Lyell McEwin Hospital. WC is a Gastroenterologist at the Royal Perth Hospital. GF is a Hepatologist at Canberra Hospital. SKR is a Hepatologist at The Alfred Hospital. Funding Information: Funding and in-kind support was received from the Commonwealth Department of Health (2018–19/05156), the Gastroenterological Society of Australia (GESA), and unrestricted research grants from Gilead Sciences, Merck, and Abbvie. Publisher Copyright: {\textcopyright} 2022, The Author(s).",
year = "2022",
month = jul,
day = "11",
doi = "10.1186/s12876-022-02416-5",
language = "English",
volume = "22",
journal = "BMC Gastroenterology",
issn = "1471-230X",
publisher = "BioMed Central",
number = "1",
}
