Awareness of HCV Infection Status Among People Who Inject Drugs in a Setting of Universal Direct-Acting Antiviral Therapy: The Ethos Engage Study

Author: Heather Valerio Maryam Alavi Alice Wheeler David Silk Marianne Martinello Anna Conway Carla Treloar Andrew Milat Adrian Dunlop Carolyn Murray Charles Henderson Janaki Amin Adrian Phillip Read Philippa Marks Louisa Degenhardt Annabelle Stevens Bianca Prain Jeremy Hayllar David Reid Mark Montebello Alexandra Wade Michael Christmass Victoria Cock Carla Gorton Gregory Dore Jason Grebely

Theme: Epidemiology & Public Health Research Year: 2022

Background: Awareness of HCV infection status among PWID empowers people with diagnosis,
enables treatment uptake, and will facilitate elimination. We aimed to evaluate awareness of HCV
infection status among PWID in an era of unrestricted HCV treatment.
Methods: ETHOS Engage is an observational cohort study of PWID attending drug treatment clinics
and needle and syringe programs in Australia. Participants completed a questionnaire containing
self-reported HCV data (including infection status: never tested, tested/unknown, no current HCV
infection [HCV RNA negative], current HCV infection [HCV RNA positive]) and underwent point-ofcare HCV RNA testing (Xpert® HCV Viral Load Fingerstick). Awareness was defined as concordant selfreported HCV status and test result. Logistic regression was used to determine factors associated
with awareness of HCV infection status.
Results: Among 2,305 PWID, 65% (n=1,506) were aware of their HCV infection status. Awareness
was higher among those who were not currently infected (70%, n=1,281/1,818) compared to those
with current HCV infection (46%, n=225/487). Among all participants, awareness was significantly
lower among those: with current HCV infection (aOR: 0.40, 95%CI: 0.30, 0.45), transgender or nonbinary (aOR: 0.27, 95%CI: 0.10, 0.75), Aboriginal and Torres Strait Islander peoples (aOR: 0.7, 95%CI:
0.59, 0.90), and who injected less than daily in the last month (vs. last injecting >12 months ago;
aOR: 0.67, 95%CI: 0.49, 0.91). Awareness was higher among those who had received opioid agonist
treatment (OAT) (vs. never receiving OAT; past: aOR: 1.61, 95%CI: 1.16, 2.24; current OAT: aOR:
1.73, 95%CI: 1.35, 2.21), and had visited a regular general practitioner in the past six months (vs. no
regular general practitioner; aOR: 1.59, 95%CI: 1.29, 1.96).
Conclusion: Among a large cohort of PWID in Australia, awareness of HCV infection status is suboptimal, with particularly concerning levels among those with active infection. Increased and
simplified testing, post-test counselling, and post-treatment monitoring is warranted.
Disclosure of Interest: None

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