Theme: Epidemiology & Public Health Research Year: 2019
Introduction: Elimination of hepatitis C virus (HCV) as a public health issue relies on high treatment
uptake. With liberal access to direct acting antivirals in Australia, and recommendations to for all
people living with HCV to be treated, most people accessing clinical services should be treated. This
study describes a cohort of individuals aware of their hepatitis C diagnosis but who have yet to
initiate treatment despite recommendation.
Methods: All clients with detectable HCV RNA worked up for DAA therapy between March 2016 and
March 2019 at the Kirketon Road Centre in Sydney were included. Clients known to have been
treated at another service were excluded. Demographic, behavioural, attendance and clinical
variables were extracted from the clinic database. Clients known to the service for > 1 month prior
to HCV assessment were considered existing clients. Factors associated with treatment uptake were
examined using odds ratios.
Results: During the timeframe 456 individuals were diagnosed and assessed for DAA treatment. Of
these 328 individuals commenced DAAs at KRC and 128 clients remain untreated. Overall treatment
uptake was therefore 72%, and 74% in existing clients. Only homelessness was associated with
reduced probability of treatment uptake OR 0.46 (95%CI 0.26-0.81, p=0.007). Recent injecting drug
use, enrolment in OAT, Aboriginality and attendance at outreach or main site locations were not
significantly associated with low treatment uptake.
Discussion: Despite high treatment uptake, a significant proportion of clients remain untreated.
Many still attend the service but have not commenced treatment despite offer. Elimination of HCV
will require strategies to support individuals who are able to access diagnostic and clinical services
yet unable or unwilling to commence treatment. Significant social instability compromised capacity
to work up and initiate these clients. Understanding reasons for not initiating treatment and
reducing loss to follow-up at this stage in the care cascade are crucial.
Disclosure of Interest Statement: The authors have no conflicts of interest to declare.