Publications & Reports

The impact of universal access to direct-acting antiviral therapy on the hepatitis C cascade of care among individuals attending primary and community health services.

Traeger MW, Pedrana AE, van Santen DK, Doyle JS, Howell J, Thompson AJ, El-Hayek C, Asselin J, Polkinghorne V, Membrey D, Bramwell F, Carter A, Guy R, Stoové MA, Hellard ME; EC Victoria Partnership and the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance of Blood-borne Viruses and Sexually Transmitted Infections (ACCESS)
Burnet Institute, Melbourne, Victoria, Australia.


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.

Link to publisher’s web site

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.