Theme: Clinical Research Year: 2019
Background: The co-EC Study supports general practitioners to initiate treatment in primary care
settings, aiming to provide proof-of-concept that treatment scale-up could eliminate coinfection
among gay and bisexual men (GBM). We report HCV treatment outcomes in primary and tertiary
care sites, and the population impact (incidence and prevalence) of HCV over time.
Methods: A nurse-led, clinician-directed trial of HCV directly acting antiviral treatment among
people with HCV/HIV co-infection was performed in Melbourne, Australia. At six sites providing care
for 75% of people with HIV in our jurisdiction, all individuals with HIV meeting standard HCV
prescribing guidelines were eligible. Primary HCV incidence and prevalence among the primary care
population was measured using a statewide surveillance system from 2012 to present.
Results: 200 participants were recruited, 55% reporting recent injecting drug use and 76%
condomless sex, of whom 177 initiated treatment in the study period 2016-2018. SVR12+ per
protocol among people treated in primary care was 97.1% (95%CI: 91.4-99.1%), which was not
significantly different to tertiary care, SVR12 100% (95%CI: 92.1-100%). 26% (46/177) required
specialist referral for HCV prescribing for advanced liver disease or other non-HIV co-morbidities.
HCV RNA prevalence among GBM with detectable HIV and HCV antibodies was 57% in 2016, which
declined to 8% (an 86% reduction) in 2018 (p<0.001). HCV incidence significantly decreased by a factor of 0.79 (95%CI 0.69-0.92, p=0.002) (a 21% reduction) each year. Conclusion: This study provides proof of concept that expanding HCV treatment access is feasible and can lead to rapid HCV elimination among GBM. Disclosure of Interest Statement: Investigator initiated funding was received from Bristol-Myers Squibb for the co-EC Study. The funders had no role in data analyses or decision to submit.