Ongoing Gaps in the Hepatitis C Care Cascade during the Direct-Acting Antiviral Era in a Large Retrospective Cohort in Canada: A Population-Based Study

Author:

Passos-Castilho Ana Maria12ORCID,Murphy Donald G.3,Blouin Karine4ORCID,Benedetti Andrea5,Panagiotoglou Dimitra5,Bruneau Julie6,Klein Marina B.7,Kwong Jeffrey C.891011,Sander Beate9101213ORCID,Janjua Naveed Z.14ORCID,Greenaway Christina1215

Affiliation:

1. Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC H3T 1E2, Canada

2. Department of Medicine, McGill University, Montreal, QC H3G 2M1, Canada

3. Laboratoire de Santé Publique du Québec, Institut National de Santé Publique du Québec, Sainte-Anne-de-Bellevue, QC H9X 3R5, Canada

4. Unité sur les Infections Transmissibles Sexuellement et par le Sang, Institut National de Santé Publique du Québec, Québec, QC H9X 3R5, Canada

5. Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, QC H3A 1G1, Canada

6. CHUM Research Centre, Centre Hospitalier de l’Université de Montréal, Montreal, QC H2X 0A9, Canada

7. Research Institute of the McGill University Health Centre, Montreal, QC H3H 2R9, Canada

8. Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada

9. ICES, Toronto, ON M4N 3M5, Canada

10. Public Health Ontario, Toronto, ON M5G 1M1, Canada

11. Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada

12. Toronto General Hospital Research Institute, University Health Network, Toronto, ON M5G 2C4, Canada

13. Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON M5T 3M6, Canada

14. School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada

15. Division of Infectious Diseases, Jewish General Hospital, Montreal, QC H3T 1E2, Canada

Abstract

To achieve hepatitis C virus (HCV) elimination, high uptake along the care cascade steps for all will be necessary. We mapped engagement with the care cascade overall and among priority groups in the post-direct-acting antivirals (DAAs) period and assessed if this changed relative to pre-DAAs. We created a population-based cohort of all reported HCV diagnoses in Quebec (1990–2018) and constructed the care cascade [antibody diagnosed, RNA tested, RNA positive, genotyped, treated, sustained virologic response (SVR)] in 2013 and 2018. Characteristics associated with RNA testing and treatment initiation were investigated using marginal logistic models via generalized estimating equations. Of the 31,439 individuals HCV-diagnosed in Quebec since 1990 and alive as of 2018, there was significant progress in engagement with the care cascade post- vs. pre-DAAs; 86% vs. 77% were RNA-tested, and 64% vs. 40% initiated treatment. As of 2018, a higher risk of not being RNA-tested or treated was observed among individuals born <1945 vs. >1965 [hazard ratio (HR); 95% CI; 1.35 (1.16–1.57)], those with material and social deprivation [1.21 (1.06–1.38)], and those with alcohol use disorder [1.21 (1.08–1.360]. Overall, non-immigrants had lower rates of RNA testing [0.76 (0.67–0.85)] and treatment initiation [0.63 (0.57–0.70)] than immigrants. As of 2018, PWID had a lower risk of not being RNA tested [0.67 (0.61–0.85)] but a similar risk of not being treated, compared to non-PWID. Engagement in the HCV care cascade have improved in the post-DAA era, but inequities remain. Vulnerable subgroups, including certain older immigrants, were less likely to have received RNA testing or treatment as of 2018 and would benefit from focused interventions to strengthen these steps.

Funder

Canadian Institutes for Health Research

Canadian Network on Hepatitis C

joint initiative of the Canadian Institutes of Health Research

Public Health Agency of Canada

Tier 1 Canada Research Chairs

Tier 2 Canada Research Chair

Fonds de recherche du Québec

University of Toronto Department of Family and Community Medicine

Publisher

MDPI AG

Reference56 articles.

1. World Health Organization (2016). Global Health Sector Strategy on Viral Hepatitis 2016–2021, WHO.

2. Canadian Network on Hepatitis C (2019). Blueprint to Inform Hepatitis C Elimination Efforts in Canada, Canadian Network on Hepatitis C.

3. The population level care cascade for hepatitis C in British Columbia, Canada as of 2018: Impact of direct acting antivirals;Bartlett;Liver Int.,2019

4. The Population Level Cascade of Care for Hepatitis C in British Columbia, Canada: The BC Hepatitis Testers Cohort (BC-HTC);Janjua;EBioMedicine,2016

5. Engagement with the HCV care cascade among high-risk groups: A population-based study;Erman;Hepatol. Commun.,2023

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