The impact of universal access to direct-acting antiviral therapy on the hepatitis C cascade of care among individuals attending primary and community health services

Michael W. Traeger, Alisa E. Pedrana, Daniela K. van Santen, Joseph S. Doyle, Jessica Howell, Alexander J. Thompson, Carol El-Hayek, Jason Asselin, Victoria Polkinghorne, Dean Membrey, Fran Bramwell, Allison Carter, Rebecca Guy, Mark A. Stoové, Margaret E. Hellard, on behalf of the EC Victoria Partnership and the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance of blood-borne viruses AND sexually transmissible infections (ACCESS)

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BACKGROUND: Hepatitis C elimination will require widespread access to treatment and responses at the health-service level to increase testing among populations at risk. We explored changes in hepatitis C testing and the cascade of care before and after the introduction of direct-acting antiviral treatments in Victoria, Australia. METHODS: De-identified clinical data were retrospectively extracted from eighteen primary care clinics providing services targeted towards people who inject drugs. We explored hepatitis C testing within three-year periods immediately prior to (pre-DAA period) and following (post-DAA period) universal access to DAA treatments on 1st March 2016. Among ever RNA-positive individuals, we constructed two care cascades at the end of the pre-DAA and post-DAA periods. RESULTS: The number of individuals HCV-tested was 13,784 (12.2% of those with a consultation) in the pre-DAA period and 14,507 (10.4% of those with a consultation) in the post-DAA period. The pre-DAA care cascade included 2,515 RNA-positive individuals; 1,977 (78.6%) were HCV viral load/genotype tested; 19 (0.8%) were prescribed treatment; and 12 had evidence of cure (0.5% of those RNA-positive and 63.6% of those eligible for cure). The post-DAA care cascade included 3,713 RNA-positive individuals; 3,276 (88.2%) were HCV viral load/genotype tested; 1,674 (45.1%) were prescribed treatment; and 863 had evidence of cure (23.2% of those RNA-positive and 94.9% of those eligible for cure). CONCLUSION: Marked improvements in the cascade of hepatitis C care among patients attending primary care clinics were observed following the universal access of DAA treatments in Australia, although improvements in testing were less pronounced.

Original languageEnglish
Article numbere0235445
Number of pages13
JournalPLoS ONE
Issue number6
Publication statusPublished - 30 Jun 2020

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