Evaluating the prevalence of current hepatitis C infection and treatment among Aboriginal and Torres Strait Islander peoples who inject drugs in Australia: The ETHOS engage study.

Introduction

Evaluating progress towards hepatitis C virus (HCV) elimination among Aboriginal and Torres Strait Islander peoples is critical given the disproportionate burden of infection. We examined factors associated with current HCV infection and self-reported treatment among Aboriginal and Torres Strait Islander (hereafter referred to as Aboriginal peoples) and non-Aboriginal peoples who inject drugs (PWID) in Australia.

Methods

ETHOS Engage is an observational cohort study of PWID attending drug treatment and needle and syringe programs in Australia. Participants underwent point-of-care HCV RNA testing (Xpert HCV RNA Viral Load Fingerstick) and completed a questionnaire including self-reported history of HCV treatment.

Results

Between May 2018 and June 2021, 2395 participants were enrolled and 555 (23%) identified as Aboriginal (median age 42 years, 58% were men, 63% injected drugs in last month, 76% ever incarcerated). HCV RNA prevalence was 23% among Aboriginal PWID (24% in 2018–2019 and 21% in 2019–2021; p = 0.44), and 21% among non-Aboriginal PWID (24% in 2018–2019 and 16% in 2019–2021; p < 0.001). Self-reported HCV treatment was 65% among Aboriginal PWID (63% in 2018–2019 and 69% in 2019–2021; p = 0.30), and 70% among non-Aboriginal PWID (67% in 2018–2019 and 75% in 2019–2021; p < 0.001). Among Aboriginal PWID, current HCV infection was associated with recently injecting drugs and receiving opioid agonist treatment, and self-reported HCV treatment was negatively associated with younger age, homelessness and recently injecting drugs.

Discussion and Conclusions

Equitable access to HCV care and prevention is needed to ensure Australia meets its elimination targets among Aboriginal PWID.