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Falling treatment uptake in the hepatitis C care cascade is a growing threat to achieving elimination

Bryce, Kathleen; Smith, Colette; Rodger, Alison; Macdonald, Douglas; (2023) Falling treatment uptake in the hepatitis C care cascade is a growing threat to achieving elimination. Journal of Viral Hepatitis , 30 (1) pp. 46-55. 10.1111/jvh.13757. Green open access

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Abstract

Most high-income countries are not on track to achieve the World Health Organization hepatitis C elimination targets. As elimination programmes assess growing proportions of patients in community-based pathways, rates of treatment uptake may fall. We aimed to identify factors associated with DAA treatment uptake and measure changes in their prevalence over time. We performed a time-to-treatment analysis on 2728 patients approved for hepatitis C Direct-Acting Antiviral treatment in the North Central London region between January 2016 and October 2019. We investigated the association between treatment uptake and factors including assessment/treatment setting (hospital, drug service or prison), patient age, gender, injection drug use, harmful alcohol use, cirrhosis status and previous treatment. The likelihood of treatment uptake was reduced by three independent risk factors. These included assessment setting: prison-based or drug-service pathways (aHR 0.29 or 0.81 vs. hospital outpatient pathway, 95% CI 0.21-0.40 and 0.70-0.94 respectively, p<0.001); being UK-born (aHR 0.89 vs. non-UK born, 0.82-0.98, p=0.01); and history of harmful alcohol use (aHR 0.84 vs. no history, 0.72-0.99, p=0.04). The average number of these risk factors for not starting treatment per patient increased over time (R2 =0.66 p<0.001). Independent of these, there was an additional 5% reduction in rate of treatment initiation in each successive year of the programme (aHR 0.95, 0.91-0.99, p=0.02). In conclusion, d isengagement from care before treatment uptake was found to be a growing threat to elimination. Despite provision of community-based test-to-cure pathways, there are persistent barriers to treatment uptake and these are increasing over time.

Type: Article
Title: Falling treatment uptake in the hepatitis C care cascade is a growing threat to achieving elimination
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/jvh.13757
Publisher version: https://doi.org/10.1111/jvh.13757
Language: English
Additional information: © 2022 The Authors. Journal of Viral Hepatitis published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/).
Keywords: Antiviral Agents, Hepatitis C, Risk Factors, Substance Abuse, Intravenous, Time-to-Treatment
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health > Infection and Population Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
URI: https://discovery.ucl.ac.uk/id/eprint/10157205
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