1. Eliminating hepatitis C in Australia: a novel model of hepatitis C testing and treatment for people who inject drugs at a medically supervised injecting facility.
- Author
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MacIsaac MB, Whitton B, Hubble A, Cogger S, Penn M, Weeks A, Elmore K, Pemberton D, Anderson J, Howard R, McKeever U, Papaluca T, Hellard ME, Stoove M, Wilson D, Pedrana A, Doyle J, Clark N, Holmes J, and Thompson AJ
- Subjects
- Humans, Antiviral Agents therapeutic use, Hepacivirus genetics, Needle-Exchange Programs, Retrospective Studies, Australia epidemiology, RNA therapeutic use, Drug Users, Hepatitis C, Chronic drug therapy, Substance Abuse, Intravenous complications, Substance Abuse, Intravenous epidemiology, Hepatitis C diagnosis, Hepatitis C drug therapy, Hepatitis C epidemiology
- Abstract
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., (© 2023 The Authors. Medical Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of AMPCo Pty Ltd.)
- Published
- 2023
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