Characterizing the Hepatitis C virus cascade of care for First Nations individuals in Ontario, Canada

Author: Andrew Mendlowitz Karen Bremner Murray Krahn Jennifer Walker William Wong Beate Sander Lyndia Jones Wanrudee Isaranuwatchai Jordan Feld Jordan

Theme: Epidemiology & Public Health Research Year: 2022

First Nations populations are a priority focus in Canada’s commitment to eliminating hepatitis C virus
(HCV). Understanding where to target efforts requires data on how individuals progress from testing and
diagnosis to treatment and cure. In partnership with the Ontario First Nations HIV/AIDS Education Circle,
we characterized the HCV care cascade for First Nations people in Ontario.
This retrospective cohort study linked individuals with First Nations status to HCV testing records from
1999 to 2018. Care stages spanned testing and diagnosis to treatment and sustained viral response
(SVR) (Figure). We mapped the cascade of care to December 31, 2018 and determined the proportion of
individuals at each stage and their characteristics, including sex, diagnosis date, region, advanced liver
disease, and mental health diagnoses. Cox regression models were used to identify associations
between characteristics and testing and treatment uptake.
Overall, 4,962 individuals (mean age 35 years, 53%(2,614) male) tested antibody positive. Before HCV
diagnosis, 3,728(75%) had a diagnosis code related to substance use. Among antibody positive
individuals, 4,118(83%) were RNA tested, with 60%(2,480) positivity; and 2,374(96%) were genotyped.
Treatment was initiated in 1,002(42%), of whom 801(80%) achieved SVR. Following SVR, 34(4%) had
reinfection or relapse (Figure). Individuals of older age, residing in a rural area, and/or with a later year
of diagnosis were more likely to undergo RNA testing, while individuals born before 1975 were less likely
(p<0.0001). Initiating treatment was more likely among individuals of older age and/or with a later year
of diagnosis, while less likely among individuals born before 1975 (all p<0.0001).
Although there have been increases in HCV testing and diagnosis among First Nations populations in
Ontario, findings suggest that a substantial gap exists in treatment initiation. Efforts should prioritize
linkage to care and consider integration with harm reduction and substance use programming.
Disclosure of Interest Statement:

This study was funded by a project grant from the Canadian Institute
of Health Research (CIHR). WW and MK have received research support from the Canadian Liver
Foundation. JF has received research support and/or consulting fees from Abbvie, Enanta, Gilead, GSK,
Janssen and Roche.

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