Hepatitis C Virus Cascades of Care in the era of Direct-Acting Antiviral Therapy

• Main Author: Yousafzai, Muhammad
• Format: Doctoral or Postdoctoral Thesis
• Language: English
• Published: UNSW, Sydney 2023
• Subjects: HCV care cascade; Viral hepatitis; HCV elimination; HCV linked data; NSW linked data; direct acting antivirals; DAA; Hepatitis C virus infection; WHO HCV elimination goals; Systematic review; anzsrc-for: 42 HEALTH SCIENCES; Iceland
• Online Access: http://hdl.handle.net/1959.4/101642; https://unsworks.unsw.edu.au/bitstreams/0f26fff6-35e4-45c5-96cf-2b597b6d1e41/download; https://doi.org/10.26190/unsworks/25349

Background: Hepatitis C virus (HCV) infection is a global public health problem. Ongoing monitoring of HCV care cascades is recommended to evaluate HCV elimination goals. Aims: Specific aims included: (1) evaluation of HCV care cascade using systematic review of global literature, and in New South Wales (NSW), Australia, (2) evaluation of HCV care cascade and its associated factors during pre-DAA (2011-2015) and DAA (2016-2018) eras, (3) factors associated with timely HCV RNA testing and treatment initiation during the DAA era, and (4) factors associated with DAA retreatment. Methods: In Chapter Two, we conducted a systematic review of global literature related to HCV care cascade from January 2014 to December 2019. In Chapters Three to Five, NSW HCV notifications linked to several administrative datasets was used to evaluate: (1) HCV care cascade during pre-DAA and DAA eras, (2) factors associated with timely HCV RNA testing, defined as testing within four weeks of HCV notification and timely treatment initiation, defined as treatment within six months of notifications, and (3) factors associated with retreatment, defined as initiation of different DAA any time after end of initial treatment date, or initiation of same DAA 28 days after last dispensation of initial treatment. Data was analysed using logistic regression. Key findings: Globally, only 11 countries reported HCV care cascade with DAA treatment uptake varied from 95% in Iceland to 8% in Sweden. In NSW, factors associated with timely HCV RNA testing and treatment initiation included age (≥ 30 years), male sex, non-Aboriginal ethnicity, country of birth Australia, and no history of drug dependence. During 2011-2012, 2013-2015, and 2016-2018, 29%, 48%, and 64% received HCV RNA testing; and 0.6%, 5%, and 38% initiated treatment, respectively. Birth cohort 1945-1964 (vs. ≥1965), males, non-Aboriginal ethnicity, and HCV/HIV co-infection were consistently associated with higher treatment uptake. In NSW, DAA retreatment was only 2.2% during 2016-2018. Early ...