Australia’s model of universal access to direct-acting
antiviral treatment for hepatitis C has been especially successful in treating
recent drug users, the group most critical to reach for the elimination of the
virus, an analysis of treatment uptake in New South Wales shows.
The findings are published in the Journal of Hepatology.
Australia made direct-acting antivirals available through
general practitioners and specialist clinics for all people with hepatitis C
from March 2016. To assess how well direct-acting antiviral treatment had
reached people who inject drugs – a key group for hepatitis C elimination in
Australia – researchers carried out an analysis of treatment uptake among
people with a history of injecting drug use in the state of New South Wales.
To identify people with hepatitis C and a history of
injecting drug use, the researchers linked recorded hepatitis C diagnoses since
1993 to death records and records of hospitalisation for a drug-related cause
such as overdose since 2001, as well as registrations for opioid substitution
therapy since 1985 or imprisonment for a drug-related offence since 1994.
The analysis excluded people who died before June 2016 and
people without Medicare records that would enable conformation of hepatitis C
The study identified 57,467 people with positive hepatitis C
antibody results estimated to have chronic hepatitis C and eligible for
inclusion in the analysis. Of these,
10,937 (19%) had evidence of drug dependence prior to 2016 and 14,938 (26%) in
the period 2016-2018.
During the 2016-2018 period, 38% of those with hepatitis C
began direct-acting antiviral treatment. However, the proportion was higher
among recent drug users; 47% started treatment, compared with 38% of those with
distant drug use (prior to 2016) or no history of drug use (33%).
People with HIV who were recent drug users and co-infected
with hepatitis C were around 70% more likely to start direct-acting antiviral
treatment compared to other recent drug users (adjusted odds ratio 1.71, 95% CI
1.24-2.36). Higher uptake among this group of drug users is probably explained by more
consistent engagement with healthcare services.
People who had been recently incarcerated were somewhat more
likely to have been treated (aOR 1.10, 95% CI 1.01-1.19), again suggesting the
importance of engagement with health services for earlier access to hepatitis C
Several groups of recent drug users were less likely to have
started treatment. Women, who formed 35% of recent drug users, were around 20%
less likely to start treatment than men (aOR 0.78, 95% CI 0.72-0.84). People of
indigenous Australian ethnicity were around 25% less likely to start treatment
(aOR 0.75, 95% CI 0.69-0.81). People born overseas were also less likely to
start treatment (aOR 0.86, 95% CI 0.76-0.86).
Women of childbearing age were less likely to have started
treatment than other women, and the researchers say that more research is
needed to look at the interaction between pregnancy and delivery and hepatitis C
screening, confirmatory testing and treatment. Women who are socially
marginalised or disengaged from health services may not be tested for hepatitis
C until the time of delivery and may have other priorities subsequently. On the
other hand, greater contact with heath services in the perinatal period may
provide greater opportunities for offering hepatitis C screening and treatment.