Bardsley, M, Heinsbroek, E, Harris, R, Croxford, S, Edmundson, C, Hope, VD, Hassan, N, Ijaz, S, Mandal, S, Shute, J, Hutchinson, SJ, Hickman, M, Sinka, K and Phipps, E (2021) The Impact of Direct-Acting Antivirals on Hepatitis C viraemia among people who inject drugs in England; real world data 2011-2018. Journal of Viral Hepatitis, 28 (10). pp. 1452-1463. ISSN 1365-2893

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Abstract

Background: Direct-acting antiviral (DAA) therapy for anybody with viraemic HCV infection has been scaled-up in England since 2017. To assess early impacts, we described trends in, and factors associated with, HCV viraemia among people who inject drugs (PWID). We also examined trends in self-reported treatment access. Methods: Bio-behavioural data from an annual, national surveillance survey of PWID (2011 to 2018) estimated trends in viraemic prevalence among HCV antibody-positive PWID. Multivariable logistic regression identified characteristics independently associated with viraemia. Trends in treatment access were examined for PWID with known infection. Findings: Between 2011 and 2016, viraemic prevalence among antibody-positive PWID remained stable (2011, 57.7%; 2016, 55.8%) but decreased in 2017 (49.4%) and 2018 (50.4%) (both p<0.001). After adjustment for demographic and behavioural characteristics, there remained significant reduction in viraemia in 2017 (adjusted odds ratio (aOR) 0.79, 95%CI 0.65-0.94) and 2018 (aOR 0.79, 95%CI 0.66-0.93) compared to 2016. Other factors associated with viraemia were male gender (aOR 1.68, 95%CI 1.53-1.86), geographical region, injecting in past year (aOR 1.26, 95%CI 1.13-1.41), imprisonment (aOR 1.14, 95%CI 1.04-1.31) and homelessness (aOR 1.17, 95%CI 1.04-1.31). Among non-viraemic PWID with known infection, the proportion reporting ever receiving treatment increased in 2017 (28.7%, p<0.001) and 2018 (38.9%, p<0.001) compared to 2016 (14.5%). Interpretation: There has been a small reduction in HCV viraemia among antibody-positive PWID in England since 2016, alongside DAA scale-up, and some indication that treatment access has improved in the same period. Population-level monitoring and focus on harm reduction is critical for achieving and evaluating elimination.

Item Type:	Article
Uncontrolled Keywords:	0605 Microbiology, 1103 Clinical Sciences, 1108 Medical Microbiology
Subjects:	Q Science > QR Microbiology Q Science > QR Microbiology > QR355 Virology R Medicine > RA Public aspects of medicine R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Divisions:	Public Health Institute
Publisher:	Wiley
Date Deposited:	29 Jun 2021 08:51
Last Modified:	10 Jan 2022 12:15
URI:	https://researchonline.ljmu.ac.uk/id/eprint/15190

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