The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia.
The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia.
Int J Drug Policy. 2022 Jul;105:103706. doi: 10.1016/j.drugpo.2022.103706. Epub 2022 May 6.
Evaluating trends in HCV treatment and prevalence is crucial for monitoring elimination. We evaluated the change in current infection and treatment among people who inject drugs (PWID) between 2018-2019 and 2019-2021.
ETHOS Engage is an observational cohort study of PWID attending drug treatment clinics and needle and syringe programs in Australia. Participant enrolment occurred over two periods, Wave 1 (May 2018-September 2019, 25 sites) and Wave 2 (November 2019-June 2021, 21 sites), with baseline questionnaire completion and point-of-care HCV RNA testing (Xpert® HCV Viral Load Fingerstick). Logistic regression was used to identify factors associated with current HCV infection and historic HCV treatment.
2,395 individuals were enrolled across the two recruitment waves (66% male, median age 43, 72% current opioid agonist therapy, and 65% injecting in the previous month). HCV prevalence decreased from 24% to 17% between 2018-2019 and 2019-2021, respectively (p=0.003). HCV treatment increased from 66% to 74% between 2018-2019 and 2019-2021, respectively (p<0.001). After adjusting, there was a reduction in current HCV infection in 2019-2021 (adjusted odds ratio [aOR] 0.62; 95% CI, 0.50, 0.77) compared to 2018-2019. Other factors associated with current infection included homelessness (aOR, 1.70; 1.26, 2.30), incarceration (vs. never; historic: aOR 1.69; 95%CI 1.31, 2.19; recent: aOR 1.85; 95%CI, 1.35, 2.54), and recently injecting drugs (vs. >12 months ago; previous month <daily: aOR 2.03; 95%CI, 1.37, 3.02; ≥daily: aOR 2.90; 95%CI, 1.94, 4.32).
The increase in HCV treatment and decrease in prevalence among PWID provides evidence of further progress towards HCV elimination; however, sub-populations may require additional support to enhance elimination.
PWID are a priority population to facilitate HCV elimination and temporal data are crucial to understand trends in HCV infection and treatment in this group. Among a cohort of PWID recruited during two different waves and in an era of unrestricted DAA therapy, prevalence of HCV infection decreased and the proportion who had received HCV treatment increased. Sub-populations of PWID-including people who are homeless, people who have been incarcerated, people who frequently inject drugs, younger people, women, and people not engaged in OAT-may require additional support to enhance HCV elimination efforts.
评估 HCV 治疗和流行率的趋势对于监测消除至关重要。我们评估了 2018-2019 年和 2019-2021 年期间注射吸毒者（PWID）中当前感染和治疗的变化。
ETHOS Engage 是一项观察性队列研究，研究对象为参加澳大利亚药物治疗诊所和针具交换计划的 PWID。参与者招募分为两个阶段，第一阶段（2018 年 5 月至 2019 年 9 月，25 个地点）和第二阶段（2019 年 11 月至 2021 年 6 月，21 个地点），进行基线问卷调查和即时护理 HCV RNA 检测（Xpert® HCV 病毒载量快速检测）。使用逻辑回归来确定与当前 HCV 感染和既往 HCV 治疗相关的因素。
在两次招募浪潮中，共有 2395 人入组（66%为男性，中位年龄为 43 岁，72%正在接受阿片类激动剂治疗，65%在过去一个月内注射毒品）。2018-2019 年和 2019-2021 年 HCV 流行率分别从 24%降至 17%（p=0.003）。2018-2019 年和 2019-2021 年 HCV 治疗率分别从 66%增加到 74%（p<0.001）。调整后，2019-2021 年与 2018-2019 年相比，当前 HCV 感染率降低（调整后的优势比 [aOR] 0.62；95%CI，0.50，0.77）。其他与当前感染相关的因素包括无家可归（aOR，1.70；1.26，2.30）、监禁（与从未监禁相比；既往：aOR 1.69；95%CI，1.31，2.19；近期：aOR 1.85；95%CI，1.35，2.54）和最近吸毒（与 >12 个月前相比；过去一个月<每天：aOR 2.03；95%CI，1.37，3.02；每天≥：aOR 2.90；95%CI，1.94，4.32）。
PWID 中 HCV 治疗的增加和流行率的降低提供了 HCV 消除进一步进展的证据；然而，亚人群可能需要额外的支持，以加强消除。
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