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

• Published in: PloS one 2020-06, Vol.15 (6), p.e0235445
• Main Authors: Traeger, Michael W, Pedrana, Alisa E, van Santen, Daniela K, Doyle, Joseph S, Howell, Jessica, Thompson, Alexander J, El-Hayek, Carol, Asselin, Jason, Polkinghorne, Victoria, Membrey, Dean, Bramwell, Fran, Carter, Allison, Guy, Rebecca, Stoové, Mark A, Hellard, Margaret E
• Format: Article
• Language: English
• Subjects: Antibodies; Antiviral agents; Antiviral drugs; Biology and life sciences; Clinics; Collaboration; Community health care; Diagnosis; Distribution; Drug therapy; Drug use; Gastroenterology; Genotypes; Harm reduction; Health care; Health care services accessibility; Health services; Health surveillance; Hepatitis; Hepatitis C; Identification methods; Infections; Infectious diseases; Influence; Interferon; Management; Medicine and health sciences; People and Places; Prescription drugs; Preventive medicine; Primary health care; Public health; Ribonucleic acid; RNA; Viruses
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0235445

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. 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 1.sup.st March 2016. Among ever RNA-positive individuals, we constructed two care cascades at the end of the pre-DAA and post-DAA periods. 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). 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.