Theme: Epidemiology and Public Health Research Year: 2021
Background: In France, universal access to direct-acting antivirals (DAA) for chronic hepatitis C (CHC) has been implemented since 2016, but certain subpopulationsremain difficult to reach, in particular people with opioid use disorders (PWOUD). We investigated whether retention in opioid agonist therapy (OAT, i.e., buprenorphine and methadone), could influence access to DAA in PWOUD with CHC. Methods: The ANRS FANTASIO project is based on exhaustive anonymous data from the French national healthcare reimbursement database. We selected 22,615 untreated individuals with CHC and at least one OAT delivery between 2012 and 2016, as a proxy of PWOUD. The study period was comprised between “baseline” (i.e. 2014 for individuals CHC-diagnosed before this date, or the year of diagnosis for the others) and first DAA delivery or censure (2016). Cox proportional hazards models were used to estimate the association between the percentage of time on OAT (pOAT) – a proxy of retention- and DAA initiation, after adjustment for baseline characteristics (sex, age, cirrhosis, liver cancer, complementary universal health coverage, and alcohol use disorder). Similarly, we tested the percentage of time on buprenorphine (pBUP) and methadone (pMET). Results: During the study period, 3,438 (15.2%) individuals initiated DAA. Average (SD) pOAT was 14.6%(23.3), 6.0%(11.3) for pBUP, and 8.6%(22.3) for pMET. After adjustment, pOAT was associated with an increased likelihood of DAA initiation (adjusted HR[95%CI]: 1.02[1.01-1.04] for a 10%-increase, p=0.001). In particular, pBUP was significantly associated with DAA initiation (1.08[1.04-1.11], p
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