Real-world outcomes of rapid regional hepatitis c virus treatment scale-up among people who inject drugs in Tayside, Scotland

Christopher J. Byrne*, Lewis Beer, Sarah K. Inglis, Emma Robinson, Andrew Radley, David J. Goldberg, Matthew Hickman, Sharon Hutchinson, John F. Dillon

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Abstract

Background
In 2017, Tayside, a region in the East of Scotland, rapidly scaled-up Hepatitis C Virus (HCV) outreach and treatment among People Who Inject Drugs (PWID) using novel community care pathways.

Aims
We aimed to determine treatment outcomes for PWID during the scale-up against pre-determined targets; and assess re-infection, mortality, and post-treatment follow up.

Methods
HCV treatment was delivered in community pharmacies, drug treatment centres, nurse-led outreach clinics, prisons, and needle exchanges, alongside conventional hospital care. We retrospectively analysed clinical outcomes and compared pathways using logistic regression models.

Results
Of 800 estimated HCV-infected PWID, 718 (90%) were diagnosed. 713 treatments commenced among 662 (92%) PWID, delivering 577 (81%) Sustained Virologic Responses (SVR). SVR was 91% among those who attended for testing. Forty-six individuals were treated more than once. Needle exchanges and community pharmacies initiated 49% of all treatments. Regression analyses implied pharmacies had superior follow-up, but there was no difference in likelihood of achieving SVR in community pathways relative to hospital care. Re-infection occurred 39 times over 256.57 person years (PY), yielding a rate of 15.20 per 100 PY (95% CI 10.81-20.78). 54 deaths occurred (29 drug related) over 1,553.04 PY, yielding a mortality rate of 3.48 per 100 PY (95% CI 2.61-4.54). Drug-related mortality was 1.87 per 100 PY (95% CI 1.25-2.68).

Conclusions
Rapid HCV treatment scale-up to PWID in community settings, whilst maintaining high SVR, is achievable. However, other interventions are required to minimise re-infection; reduce drug-related deaths; and improve post-SVR follow-up testing regionally.
Original languageEnglish
JournalAlimentary Pharmacology and Therapeutics
Early online date8 Dec 2021
DOIs
Publication statusE-pub ahead of print - 8 Dec 2021

Keywords

  • hepatitis C virus
  • People Who Inject Drugs
  • re-infection
  • rapid HCV treatment scale-up

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