Eliminating Structural Barriers: The Impact of Unrestricted Access on Hepatitis C Treatment Uptake Among People Living With Human Immunodeficiency Virus

Overview

Journal Clin Infect Dis

Publisher Oxford University Press

Specialty Infectious Diseases

Date 2019 Sep 11

PMID 31504327

Citations 18

Authors

Sahar Saeed

Erin Strumpf

Erica E M Moodie

Leo Wong

Joseph Cox

Sharon Walmsley

Mark Tyndall

Curtis Cooper

Brian Conway

Mark Hull

Valerie Martel-Laferriere

John Gill

Alexander Wong

Marie-Louise Vachon

Marina B Klein

Affiliations

Soon will be listed here.

Abstract

Background: High costs of direct-acting antivirals (DAAs) have led health-care insurers to limit access worldwide. Using a natural experiment, we evaluated the impact of removing fibrosis stage restrictions on hepatitis C (HCV) treatment initiation rates among people living with human immunodeficiency virus (HIV), and then examined who was left to be treated.

Methods: Using data from the Canadian HIV-HCV Coinfection Cohort, we applied a difference-in-differences approach. Changes in treatment initiation rates following the removal of fibrosis stage restrictions were assessed using a negative binomial regression with generalized estimating equations. The policy change was then specifically assessed among people who inject drugs (PWID). We then identified the characteristics of participants who remained to be treated using a modified Poisson regression.

Results: Between 2010-2018, there were a total of 585 HCV initiations among 1130 eligible participants. After removing fibrosis stage restrictions, DAA initiations increased by 1.8-fold (95% confidence interval [CI] 1.3-2.4) controlling for time-invariant differences and secular trends. Among PWID the impact appeared even stronger, with an adjusted incidence rate ratio of 3.6 (95% CI 1.8-7.4). However, this increased treatment uptake was not sustained. At 1 year following universal access, treatment rates declined to 0.8 (95% CI .5-1.1). Marginalized participants (PWID and those of indigenous ethnicity) and those disengaged from care were more likely to remain HCV RNA positive.

Conclusions: After the removal of fibrosis restrictions, HCV treatment initiations nearly doubled immediately, but this treatment rate was not sustained. To meet the World Health Organization elimination targets, the minimization of structural barriers and adoption of tailored interventions are needed to engage and treat all vulnerable populations.

Citing Articles

Impact of Policy Changes Expanding Access to Direct-Acting Antivirals on Hepatitis C Virus-Related Hospitalizations in People With HIV: A Population-Based Study.

Antoniou T, Ledlie S, Wang T, Tadrous M, Gomes T Open Forum Infect Dis. 2025; 12(1):ofaf003.

PMID: 39877398 PMC: 11773189. DOI: 10.1093/ofid/ofaf003.

Hepatitis C Diagnosis and Treatment Among Indigenous People in a Canadian Context: Challenges and Community-Led Solutions.

Dunn K, Biondi M, Lee S Microorganisms. 2024; 12(11).

PMID: 39597752 PMC: 11596142. DOI: 10.3390/microorganisms12112364.

Disengagement from Care Among People Co-Infected with HIV and HCV: A Scoping Review.

Dinh D, Tan Y, Saeed S AIDS Behav. 2024; 28(10):3381-3403.

PMID: 38992228 DOI: 10.1007/s10461-024-04436-6.

Frequent Disengagement and Subsequent Mortality Among People With HIV and Hepatitis C in Canada: A Prospective Cohort Study.

Saeed S, Thomas T, Dinh D, Moodie E, Cox J, Cooper C Open Forum Infect Dis. 2024; 11(5):ofae239.

PMID: 38798898 PMC: 11127478. DOI: 10.1093/ofid/ofae239.

Adherence and sustained virologic response among vulnerable people initiating an hepatitis C treatment at a nurse-led clinic: A non-experimental prospective cohort study based on clinical records.

Gagne M, Tetu I, Gregoire J, Moisan J Int J Nurs Stud Adv. 2024; 3:100029.

PMID: 38746734 PMC: 11080331. DOI: 10.1016/j.ijnsa.2021.100029.

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