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The Population Level Cascade of Care for Hepatitis C in British Columbia, Canada: The BC Hepatitis Testers Cohort (BC-HTC)
Population-level monitoring of hepatitis C virus (HCV) infected people across the cascade of care identifies gaps in access and engagement in care and treatment. We characterized a population-level cascade of care for HCV in British Columbia (BC), Canada and identified factors associated with leakag...
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Published in: | EBioMedicine 2016-10, Vol.12 (C), p.189-195 |
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Main Authors: | , , , , , , , , , , , , |
Format: | Article |
Language: | English |
Subjects: | |
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Online Access: | Get full text |
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Summary: | Population-level monitoring of hepatitis C virus (HCV) infected people across the cascade of care identifies gaps in access and engagement in care and treatment. We characterized a population-level cascade of care for HCV in British Columbia (BC), Canada and identified factors associated with leakage at each stage.
The BC Hepatitis Testers Cohort (BC-HTC) includes 1.5million individuals tested for HCV, HIV, reported cases of hepatitis B, and active tuberculosis in BC from 1990 to 2013 linked to medical visits, hospitalizations, cancers, prescription drugs and mortality data. We defined six HCV cascade of care stages: 1) estimated population prevalence; 2) HCV diagnosed; 3) HCV RNA tested; 4) genotyped; 5) initiated treatment; and 6) achieved sustained virologic response (SVR).
We estimated that 73,203 people were HCV antibody positive in BC in 2012 (undiagnosed: 18,301, 25%; diagnosed: 54,902, 75%). Of these, 56%(40,656) had HCV RNA testing; 34%(26,300) were genotyped; 12%( 8532 ) had received interferon-based therapy and 7%(5197) had SVR. Males, older birth cohorts, and HBV coinfected were less likely to undergo HCV RNA testing. Among those with chronic HCV infection, 32% had received liver-related care. Retention in liver care was more likely in those with HIV, cirrhosis, and drug/alcohol use and less likely in males and HBV coinfected.
Although there are gaps in HCV RNA testing and genotyping after HCV diagnosis, the major gap in the cascade of care was low treatment initiation. People with comorbidities progressed through the cascade of testing and care but few received treatment.
•Integration of various data sources enables HCV monitoring across the care cascade to assess program effectiveness.•The majority of anti-HCV positive individuals were tested for RNA and genotyping.•Very small proportion of HCV infected individuals received treatment.•People with HIV coinfection and drug use despite being in liver care were less likely to receive treatment.
We have assembled data on all individuals testing for hepatitis C in British Columbia to establish a system to monitor infection and care. The majority of the individuals testing positive for anti- HCV antibodies were tested for hepatitis C RNA and subsequently genotyping, both needed for treatment. However, very small percentage received interferon-based hepatitis C treatment and it was successful in about half of them. People with HIV co-infection and drug use were more likely to receive liver care but t |
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ISSN: | 2352-3964 2352-3964 |
DOI: | 10.1016/j.ebiom.2016.08.035 |