Design, setting and participants: Natural experiment, evaluated using data from national biennial surveys of PWID and national clinical data. Services providing injecting equipment (2010–18) and HCV treatment clinics (2017–18) across Scotland. A total of 12 492 PWID who completed a questionnaire and provided a blood spot (tested for HCV-antibodies and RNA); 4105 individuals who initiated HCV treatment.
Intervention and comparator, measurements: The intervention was rapid DAA scale-up among PWID, which occurred in Tayside. The comparator was GGC/RoS. Trends in HCV viraemia and uptake of HCV therapy over time; sustained viral response (SVR) rates to therapy by region and treatment setting.
Findings: Uptake of HCV therapy (last year) among PWID between 2013–14 and 2017–18 increased from 15 to 43% in Tayside, 6 to 16% in GGC and 11 to 23% in RoS. Between 2010 and 2017–18, the prevalence of HCV viraemia (among antibody-positives) declined from 73 to 44% in Tayside, 67 to 58% in GGC and 64 to 55% in RoS. The decline in viraemia was greater in Tayside [2017–18 adjusted odds ratio (aOR) = 0.47, 95% confidence interval (CI) = 0.30–0.75, P = 0.001] than elsewhere in Scotland (2017–18 aOR = 0.89, 95% CI = 0.74–1.07, P = 0.220) relative to the baseline of 2013–14 in RoS (including GGC). Per-protocol SVR rates among PWID treated in community sites did not differ from those treated in hospital sites in Tayside (97.4 versus 100.0%, P = 0.099).
Conclusions: Scale-up of direct-acting anti-viral treatment among people who inject drugs can be achieved through hepatitis C virus (HCV) testing and treatment in community drug services while maintaining high sustained viral response rates and, in the Tayside region of Scotland, has led to a substantial reduction in chronic HCV in the population.
- Hepatitis C, chronic
- direct-acting anti-virals
- sustained viral response
- substance abuse, intravenous