Declining prevalence of current HCV infection and increased treatment uptake among people who inject drugs: The ETHOS Engage study.

Adult Antiviral Agents / therapeutic use Drug Users Female Hepatitis C / complications Hepatitis C, Chronic / drug therapy Humans Male Prevalence Substance Abuse, Intravenous / complications
Direct-acting antiviral era Hepatitis C virus elimination Hepatitis C virus infection Hepatitis C virus treatment People who inject drugs

Journal

The International journal on drug policy
ISSN: 1873-4758
Titre abrégé: Int J Drug Policy
Pays: Netherlands
ID NLM: 9014759

Informations de publication

Date de publication:
07 2022
Historique:
received: 02 11 2021
revised: 05 04 2022
accepted: 13 04 2022
pubmed: 10 5 2022
medline: 29 6 2022
entrez: 9 5 2022
Statut: ppublish

Résumé

Evaluating trends in HCV treatment and prevalence is crucial for monitoring elimination. We evaluated the change in current infection and treatment among people who inject drugs (PWID) between 2018-2019 and 2019-2021. ETHOS Engage is an observational cohort study of PWID attending drug treatment clinics and needle and syringe programs in Australia. Participant enrolment occurred over two periods, Wave 1 (May 2018-September 2019, 25 sites) and Wave 2 (November 2019-June 2021, 21 sites), with baseline questionnaire completion and point-of-care HCV RNA testing (Xpert® HCV Viral Load Fingerstick). Logistic regression was used to identify factors associated with current HCV infection and historic HCV treatment. 2,395 individuals were enrolled across the two recruitment waves (66% male, median age 43, 72% current opioid agonist therapy, and 65% injecting in the previous month). HCV prevalence decreased from 24% to 17% between 2018-2019 and 2019-2021, respectively (p=0.003). HCV treatment increased from 66% to 74% between 2018-2019 and 2019-2021, respectively (p<0.001). After adjusting, there was a reduction in current HCV infection in 2019-2021 (adjusted odds ratio [aOR] 0.62; 95% CI, 0.50, 0.77) compared to 2018-2019. Other factors associated with current infection included homelessness (aOR, 1.70; 1.26, 2.30), incarceration (vs. never; historic: aOR 1.69; 95%CI 1.31, 2.19; recent: aOR 1.85; 95%CI, 1.35, 2.54), and recently injecting drugs (vs. >12 months ago; previous month <daily: aOR 2.03; 95%CI, 1.37, 3.02; ≥daily: aOR 2.90; 95%CI, 1.94, 4.32). The increase in HCV treatment and decrease in prevalence among PWID provides evidence of further progress towards HCV elimination; however, sub-populations may require additional support to enhance elimination. PWID are a priority population to facilitate HCV elimination and temporal data are crucial to understand trends in HCV infection and treatment in this group. Among a cohort of PWID recruited during two different waves and in an era of unrestricted DAA therapy, prevalence of HCV infection decreased and the proportion who had received HCV treatment increased. Sub-populations of PWID-including people who are homeless, people who have been incarcerated, people who frequently inject drugs, younger people, women, and people not engaged in OAT-may require additional support to enhance HCV elimination efforts.

Sections du résumé

BACKGROUND
Evaluating trends in HCV treatment and prevalence is crucial for monitoring elimination. We evaluated the change in current infection and treatment among people who inject drugs (PWID) between 2018-2019 and 2019-2021.
METHODS
ETHOS Engage is an observational cohort study of PWID attending drug treatment clinics and needle and syringe programs in Australia. Participant enrolment occurred over two periods, Wave 1 (May 2018-September 2019, 25 sites) and Wave 2 (November 2019-June 2021, 21 sites), with baseline questionnaire completion and point-of-care HCV RNA testing (Xpert® HCV Viral Load Fingerstick). Logistic regression was used to identify factors associated with current HCV infection and historic HCV treatment.
RESULTS
2,395 individuals were enrolled across the two recruitment waves (66% male, median age 43, 72% current opioid agonist therapy, and 65% injecting in the previous month). HCV prevalence decreased from 24% to 17% between 2018-2019 and 2019-2021, respectively (p=0.003). HCV treatment increased from 66% to 74% between 2018-2019 and 2019-2021, respectively (p<0.001). After adjusting, there was a reduction in current HCV infection in 2019-2021 (adjusted odds ratio [aOR] 0.62; 95% CI, 0.50, 0.77) compared to 2018-2019. Other factors associated with current infection included homelessness (aOR, 1.70; 1.26, 2.30), incarceration (vs. never; historic: aOR 1.69; 95%CI 1.31, 2.19; recent: aOR 1.85; 95%CI, 1.35, 2.54), and recently injecting drugs (vs. >12 months ago; previous month <daily: aOR 2.03; 95%CI, 1.37, 3.02; ≥daily: aOR 2.90; 95%CI, 1.94, 4.32).
CONCLUSION
The increase in HCV treatment and decrease in prevalence among PWID provides evidence of further progress towards HCV elimination; however, sub-populations may require additional support to enhance elimination.
LAY SUMMARY
PWID are a priority population to facilitate HCV elimination and temporal data are crucial to understand trends in HCV infection and treatment in this group. Among a cohort of PWID recruited during two different waves and in an era of unrestricted DAA therapy, prevalence of HCV infection decreased and the proportion who had received HCV treatment increased. Sub-populations of PWID-including people who are homeless, people who have been incarcerated, people who frequently inject drugs, younger people, women, and people not engaged in OAT-may require additional support to enhance HCV elimination efforts.

Identifiants

DOI: 10.1016/j.drugpo.2022.103706 PMID: 35533635
pubmed: 35533635
pii: S0955-3959(22)00125-6
doi: 10.1016/j.drugpo.2022.103706
pii:
doi:

Substances chimiques

Antiviral Agents 0

Types de publication

Journal Article Observational Study Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

103706

Informations de copyright

Copyright © 2022 Elsevier B.V. All rights reserved.

Déclaration de conflit d'intérêts

Declarations of Interest JG reports grants from Camurus, grants from Cepheid, grants from Hologic, grants from Indivior, grants from Merck, during the conduct of the study; grants and personal fees from Abbvie, grants and personal fees from Gilead Sciences, grants and personal fees from Merck, grants and personal fees from Cepheid, outside the submitted work. GD reports grants from Gilead, Abbvie, and Merck. LD has received investigator-initiated untied educational grants for studies of opioid medications in Australia from Indivior, Mundipharma and Seqirus. All remaining authors have no potential conflicts to declare.

Auteurs

Heather Valerio (H)

The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia. Electronic address: hvalerio@kirby.unsw.edu.au.

Maryam Alavi (M)

The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia.

Anna Conway (A)

The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia.

David Silk (D)

The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia.

Carla Treloar (C)

Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia.

Marianne Martinello (M)

The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia.

Andrew Milat (A)

Centre for Epidemiology and Evidence, NSW Health, New South Wales, Australia.

Adrian Dunlop (A)

Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, New South Wales, Australia; Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia.

Carolyn Murray (C)

Population Health Strategy & Performance, NSW Health, New South Wales, Australia.

Charles Henderson (C)

NSW Users and AIDS Association, New South Wales, Australia.

Janaki Amin (J)

Department of Health Sciences, Macquarie University, Sydney, New South Wales, Australia.

Phillip Read (P)

Kirketon Road Centre, Sydney, New South Wales, Australia.

Philippa Marks (P)

The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia.

Louisa Degenhardt (L)

National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia.

Annabelle Stevens (A)

Centre for Population Health, NSW Health, New South Wales, Australia.

Bianca Prain (B)

Centre for Population Health, NSW Health, New South Wales, Australia.

Jeremy Hayllar (J)

Alcohol and Drug Service, Metro North Mental Health, Metro North Hospital and Health Service, Brisbane, Queensland, Australia.

David Reid (D)

Drug and Alcohol Service, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia.

Mark Montebello (M)

North Sydney Local Health District, Sydney, New South Wales, Australia.

Alexandra Wade (A)

Mid North Coast Local Health District, New South Wales, Australia.

Michael Christmass (M)

Next Step Drug and Alcohol Service, Perth, Western Australia, Australia; National Drug Research Institute, Curtin University, Perth, Western Australia, Australia.

Victoria Cock (V)

Drug and Alcohol Services South Australia, Adelaide, South Australia, Australia.

Gregory J Dore (GJ)

The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia.

Jason Grebely (J)

The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Declining prevalence of current HCV infection...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Anti-infectieux › Antiviraux › Declining prevalence of current HCV infection...
questionsmedicales.fr › Personnes › Usagers de drogues › Declining prevalence of current HCV infection...
questionsmedicales.fr › Maladies de l'appareil digestif › Maladies du foie › Hépatite › Hépatites virales humaines › Hépatite C › Declining prevalence of current HCV infection...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Caractéristiques de la maladie › Maladie chronique › Hépatite chronique › Hépatite C chronique › Declining prevalence of current HCV infection...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Declining prevalence of current HCV infection...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Registre civil › Morbidité › Prévalence › Declining prevalence of current HCV infection...
questionsmedicales.fr › Troubles mentaux › Troubles liés à une substance › Toxicomanie intraveineuse › Declining prevalence of current HCV infection...