Disparities in uptake of direct‐acting antiviral therapy for hepatitis C among people who inject drugs in a Canadian setting
Background & Aims Despite the high burden of hepatitis C virus (HCV) infection among people who inject drugs (PWID), uptake of interferon‐based therapies has been extremely low. Increasing availability of direct‐acting antiviral (DAA)‐based therapies offers the possibility of rapid treatment exp...
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Published in | Liver international Vol. 39; no. 8; pp. 1400 - 1407 |
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Main Authors | , , , , , , , |
Format | Journal Article |
Language | English |
Published |
United States
Wiley Subscription Services, Inc
01.08.2019
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Subjects | |
Online Access | Get full text |
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Summary: | Background & Aims
Despite the high burden of hepatitis C virus (HCV) infection among people who inject drugs (PWID), uptake of interferon‐based therapies has been extremely low. Increasing availability of direct‐acting antiviral (DAA)‐based therapies offers the possibility of rapid treatment expansion with the goal of controlling the HCV epidemic. We evaluated DAA‐based treatment uptake among HCV‐positive PWID in Vancouver after introduction of DAAs in the government drug formulary.
Methods
Using data from three cohorts of PWID in Vancouver, Canada, we investigated factors associated with DAA‐therapies uptake among participants with HCV between April 2015 and November 2017.
Results
Of the 915 HCV‐positive PWID, 611 (66.8%) were recent PWID and 369 (40.3%) had HIV coinfection. During the study period, 146 (16.0%) initiated DAA‐therapies, a rate of 6.0 per 100 person‐year, with higher initiation rates among non‐recent PWID and an increasing trend over time. In multivariable analysis, HIV coinfection (Adjusted Odds Ratio [AOR] = 2.29, 95% Confidence Interval [CI]: 1.55‐3.40), white race (AOR = 1.56, 95% CI: 1.05‐2.35), and engagement in HCV care (AOR = 1.94, 95% CI: 1.31‐2.90) were positively associated with DAA‐therapies uptake, while high‐risk drinking (AOR = 0.47, 95% CI: 0.23‐0.88) and daily crack use were negatively associated (AOR = 0.41, 95% CI: 0.17‐0.85). Among recent PWID, engagement in opioid agonist therapy emerged as an independent correlate of DAA uptake.
Conclusions
Despite increases in HCV treatment uptake among PWID after the introduction of DAAs in our setting, disparities in access remain. Social‐structural and behavioural barriers to HCV care should be addressed for the success of any HCV elimination strategy. |
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Bibliography: | Funding information This work was supported by the US National Institute on Drug Abuse (NIDA) (U01‐DA038886 and U01‐DA021525). MES is supported by a Michael Smith Foundation for Health Research (MSFHR)/St Paul's Foundation Scholar Award. M‐JM is supported by NIDA (U01‐DA021525), and CIHR New Investigator and MSFHR Scholar Awards. EW is supported by a Tier 1 Canada Research Chair in Inner City Medicine. LT is supported by a MSFHR Scholar Award. KH is supported by the St. Paul's Foundation, and CIHR New Investigator and MSFHR Scholar Awards. KD is supported by MSFHR/St. Paul's Hospital Foundation Scholar Award and CIHR New Investigator Awards. Handling Editor: Alessio Aghemo ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 1478-3223 1478-3231 |
DOI: | 10.1111/liv.14043 |