Use of direct-acting antivirals (DAAs) in people who inject drugs (PWID) has increased markedly in the era of unrestricted access to the drugs, however uptake remains suboptimal at just 38%.
An observational cohort study of 853 PWID from 16 community-based sites in NSW and Queensland found 45% had detectable HCV RNA on enrolment, consistent with active infection.
Most (64%) reported injecting drugs in the month prior to enrolment and a similar number (67%) reported receiving opioid substitution treatment at baseline.
More than a third (38%) also screened positive for high-risk alcohol consumption.
“As expected, significant liver fibrosis (F2 – F4) was more common in participants with HCV infection (38%) compared to those without (19%) (p<0.001),” the study said.
Older age (36-50 years) and obesity (BMI ≥30) were also associated with fibrosis in participants irrespective of detectable HCV RNA.
The LiveRLife study, which combined health promotion and linkage to care, found 45% of participants returned for clinical follow-up as recommended.
Of those with HCV infection, 34% were receiving or had initiated HCV treatment.
Before unrestricted DAA access from March 2016, only 2% of the study participants initiated interferon-based treatment.
“In contrast, among participants enrolled post DAA access, 38% of participants with HCV infection were receiving or initiated HCV treatment within 12 months of HCV screening.”
Age ≥50 years and a clinical follow-up with a nurse of physician were associated with DAA treatment uptake.
“Although encouraging, the 38% DAA era treatment uptake remains suboptimal and highlights the need for the development and evaluation of acceptable and innovative strategies tailored to PWID,” the study led by The Kirby Institute said.
It said ongoing barriers to accessing care and treatment among PWID included the belief that HCV infection was inevitable, complex life situations, competing priorities, and fear of diagnosis, side effects and adverse treatment outcomes.
“Further, many PWID report persistent feelings of being stigmatised by health providers and being undeserving of treatment (particularly due to high DAA cost) and perceived lack of referral and treatment.”
The study noted ageing PWID populations are driving an increased liver disease burden through high HCV prevalence, but also through chronic conditions such as type 2 diabetes and fatty liver disease.
“Comprehensive, innovative and acceptable models of care that also address the structural and social determinants of access to care, and strategies such as outreach to engage hard to reach populations, are required,” it concluded.