The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia.
J Viral Hepat. 2022 Apr;29(4):271-279. doi: 10.1111/jvh.13658. Epub 2022 Feb 25.
People living with HIV (PLHIV) are a priority population to receive hepatitis C virus (HCV) screening and treatment. We aimed to characterize the HCV care cascade among PLHIV between 2010 and 2018 and to compare HCV testing and treatment uptake pre- and post-availability of direct-acting antivirals (DAAs) in New South Wales (NSW), Australia. Records of all HCV notifications (1993-2017) were linked to HIV notifications, deaths, hospitalizations, incarcerations, opioid agonist therapy, HCV RNA testing and treatment databases. Numbers and proportions were calculated for all stages of the care cascade and factors associated with HCV testing, and DAA treatment uptake were evaluated using logistic regression. From 383 individuals with HCV notification (2009-2017), 349 (91%) were ever HCV RNA tested, 285 (74%) had an indicator of chronic HCV infection, and from those eligible for treatment, 210 (74%) received HCV treatment. HCV testing was recorded for 85% pre-DAA era and reached a cumulative proportion of 90% post-DAA while treatment uptake had a 10-fold increase from 7% pre- to 73% post-DAA era. Younger age (adjusted odds ratio [aOR] 0.98; 95% CI 0.96-0.99), female gender (aOR 1.87; 95% CI 1.10-3.19), and rural region residence at notification (aOR 1.56; 95% CI 1.03-2.36) were associated with not receiving HCV testing. No identified factor was associated with not receiving treatment post-DAA era. Removing barriers to HCV testing, expanding treatment to a variety of settings and continuous education and harm reduction are essential to achieve HCV elimination among PLHIV in Australia.
HIV 感染者（PLHIV）是接受丙型肝炎病毒（HCV）筛查和治疗的重点人群。本研究旨在描述 2010 年至 2018 年期间 PLHIV 中的 HCV 护理路径，并比较澳大利亚新南威尔士州（NSW）直接作用抗病毒药物（DAA）可用前后 HCV 检测和治疗的采用情况。将所有 HCV 通知记录（1993-2017 年）与 HIV 通知、死亡、住院、监禁、阿片类药物激动剂治疗、HCV RNA 检测和治疗数据库相关联。计算了 HCV 护理路径各个阶段的数量和比例，并使用逻辑回归评估了 HCV 检测和 DAA 治疗采用的相关因素。在 383 名 HCV 通知患者（2009-2017 年）中，349 名（91%）曾进行过 HCV RNA 检测，285 名（74%）有慢性 HCV 感染的指标，在有治疗资格的患者中，210 名（74%）接受了 HCV 治疗。DAA 前时代 HCV 检测记录率为 85%，DAA 后时代达到了 90%的累积比例，而治疗采用率从 DAA 前的 7%增加到了 DAA 后的 73%。年龄较小（调整后的优势比 [aOR] 0.98；95%置信区间 0.96-0.99）、女性（aOR 1.87；95%置信区间 1.10-3.19）和 HCV 通知时居住在农村地区（aOR 1.56；95%置信区间 1.03-2.36）与未接受 HCV 检测相关。在 DAA 后时代，没有确定的因素与未接受治疗相关。消除 HCV 检测障碍，将治疗扩展到各种环境，并进行持续的教育和减少伤害，对于在澳大利亚实现 HIV 感染者的 HCV 消除至关重要。
