Gliddon, HD, Ward, Z, Heinsbroek, E, Croxford, S, Edmundson, C, Hope, VD, Simmons, R, Mitchell, H, Hickman, M, Vickerman, P and Stone, J (2024) Has the HCV cascade of care changed among people who inject drugs in England since the introduction of direct-acting antivirals? International Journal of Drug Policy. p. 104324. ISSN 0955-3959

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Abstract

Background In England, over 80 % of those with hepatitis C virus (HCV) infection have injected drugs. We quantified the HCV cascade of care (CoC) among people who inject drugs (PWID) in England and determined whether this improved after direct-acting antivirals (DAAs) were introduced. Methods We analysed data from nine rounds of national annual cross-sectional surveys of PWID recruited from drug services (2011–2019; N = 12,320). Study rounds were grouped as: 'Pre-DAAs’ (2011–2014), ‘Prioritised DAAs’ (2015–2016) and 'Unrestricted DAAs’ (2017–2019). Participants were anonymously tested for HCV antibodies and RNA and completed a short survey. We assessed the proportion of PWID recently (current/previous year) tested for HCV. For participants ever HCV treatment eligible (past chronic infection with history of treatment or current chronic infection), we assessed the CoC as: HCV testing (ever), received a positive test result, seen a specialist nurse/doctor, and ever treated. We used logistic regression to determine if individuals progressed through the CoC differently depending on time-period, whether time-period was associated with recent testing (all participants) and lifetime HCV treatment (ever eligible participants), and predictors of HCV testing and treatment in the Unrestricted DAAs period. Results The proportion of ever HCV treatment eligible PWID reporting lifetime HCV treatment increased from 12.5 % in the Pre-DAAs period to 25.6 % in the Unrestricted DAAs period (aOR:2.40, 95 %CI:1.95–2.96). There were also increases in seeing a specialist nurse/doctor. The largest loss in the CoC was at treatment for all time periods. During the Unrestricted DAAs period, recent (past year) homelessness (vs never, aOR:0.66, 95 %CI:0.45–0.97), duration of injecting (≤3 years vs >3 years; aOR:0.26, 95 %CI:0.12–0.60), never (vs current, aOR:0.31, 95 %CI:0.13–0.75) or previously being prescribed OAT (vs current, aOR:0.67, 95 %CI:0.47-0.95), and never using a NSP (vs past year, aOR:0.27, 95 %CI:0.08–0.89) were negatively associated with lifetime HCV treatment. The proportion of PWID reporting recent HCV testing was higher during Unrestricted DAAs (56 %) compared to Pre-DAAs (48 %; aOR:1.28, 95 %CI:1.06–1.54).Conclusion COC stages from seeing a specialist onwards improved after DAAs became widely available. Further improvements in HCV testing are needed to eliminate HCV in England.

Item Type:	Article
Uncontrolled Keywords:	11 Medical and Health Sciences; 16 Studies in Human Society; 17 Psychology and Cognitive Sciences; Substance Abuse
Subjects:	R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Divisions:	Public Health Institute Vice-Chancellor's Office
Publisher:	Elsevier
SWORD Depositor:	A Symplectic
Date Deposited:	15 Jan 2024 12:23
Last Modified:	15 Jan 2024 12:23
DOI or ID number:	10.1016/j.drugpo.2024.104324
URI:	https://researchonline.ljmu.ac.uk/id/eprint/22275

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