Abstract

BACKGROUND: Hepatitis C elimination will require widespread access to treatment and responses at the health-service level to increase testing among populations at risk. We explored changes in hepatitis C testing and the cascade of care before and after the introduction of direct-acting antiviral treatments in Victoria, Australia. METHODS: De-identified clinical data were retrospectively extracted from eighteen primary care clinics providing services targeted towards people who inject drugs. We explored hepatitis C testing within three-year periods immediately prior to (pre-DAA period) and following (post-DAA period) universal access to DAA treatments on 1st March 2016. Among ever RNA-positive individuals, we constructed two care cascades at the end of the pre-DAA and post-DAA periods. RESULTS: The number of individuals HCV-tested was 13,784 (12.2% of those with a consultation) in the pre-DAA period and 14,507 (10.4% of those with a consultation) in the post-DAA period. The pre-DAA care cascade included 2,515 RNA-positive individuals; 1,977 (78.6%) were HCV viral load/genotype tested; 19 (0.8%) were prescribed treatment; and 12 had evidence of cure (0.5% of those RNA-positive and 63.6% of those eligible for cure). The post-DAA care cascade included 3,713 RNA-positive individuals; 3,276 (88.2%) were HCV viral load/genotype tested; 1,674 (45.1%) were prescribed treatment; and 863 had evidence of cure (23.2% of those RNA-positive and 94.9% of those eligible for cure). CONCLUSION: Marked improvements in the cascade of hepatitis C care among patients attending primary care clinics were observed following the universal access of DAA treatments in Australia, although improvements in testing were less pronounced.

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The authors acknowledge the contribution of the ACCESS Team members who are not coauthors of this article including: Lisa Bastian, WA Health; Deborah Bateson, Family Planning NSW; Scott Bowden, Doherty Institute; Mark Boyd, University of Adelaide; Denton Callander, Kirby Institute, UNSW Sydney; Aaron Cogle, National Association of People with HIV Australia; Wayne Dimech, NRL; Basil Donovan, Kirby Institute, UNSW Sydney; Jeanne Ellard, Australian Federation of AIDS Organisations; Kit Fairley, Melbourne Sexual Health Centre; Jane Hocking, University of Melbourne; Jules Kim, Scarlet Alliance; Scott McGill, Australasian Society for HIV Medicine; David Nolan, Royal Perth Hospital; Prital Patel, Kirby Institute, UNSW Sydney; Stella Pendle, Australian Clinical Laboratories; Philip Reed, Kirkton Road Centre; Norm Roth, Prahran Market Clinic; Nathan Ryder, Christine Selvey, NSW Ministry of Health; Nicola Stephens, Victorian Department of Health; Helen Tyrrell, Hepatitis Australia; Toby Vickers, Kirby Institute, UNSW Sydney; Melanie Walker, Australian Injecting and Illicit Drug Users League; Michael West, Victorian Department of Health. The authors also acknowledge all clinics participating in ACCESS, including the site investigators who contributed data to this analysis: ACCESS is a collaboration between the Burnet Institute, Kirby Institute and National Reference Laboratory.