2895. Threats to Successful Elimination of Viral Hepatitis: Results from the Nationwide Treatment as Prevention for Hepatitis C (TraP HepC) Program in Iceland

Abstract Background The main driver of the Hepatitis C virus (HCV) epidemic in most western countries is injection drug use (IDU) among people who inject drugs (PWID). Iceland has provided unrestricted access to direct-acting antiviral agents (DAA) to all HCV-infected patients in the country covered by national health insurance, by a program entitled Treatment as Prevention for Hepatitis C (TraP HepC) from 2016 and is on track to become among the first to achieve the WHO goals of eliminating HCV as a public health threat. Methods We analyzed data regarding testing for HCV, incidence of IDU, prevalence of HCV viremia among PWID, drug use in the community and trends in homelessness prior to and during the first 24 months of TraP HepC to monitor outcomes and identify new or persistent challenges. Results Intensity of nationwide testing for HCV increased by 22% in 2016, 60% in 2017, and 81% in 2018 compared with previous years (P < 0.001). During 2016–2018 the incidence of new injection drug use, as surveyed among those admitted for addiction treatment increased by 48%. The total number of PWID admitted annually with HCV viremia however remained relatively stable during the entire period (2010–2018). The prevalence of HCV viremia among people recently injecting drugs admitted for addiction treatment however dropped from 48.7% to 16.2% in 2017, and to 10.2% in 2018 (P < 0.001). Analysis of data regarding stimulant use, as measured by drug levels in wastewater shows an almost threefold increase of amphetamine and an eightfold increase in cocaine levels during 2016–2018 compared with 2015. Concurrently, the number of homeless has doubled. Two years into TraP HepC > 80% of the estimated total HCV-infected population were started on their first course of DAAs. By intention to treat analysis, the cure rate was 92.4% among patients without history of IDU in the past 6 months, compared with 82.9% among active IDU (P = 0.0006); those with history of recent IDU were more likely to discontinue (P < 0.0001). Homelessness carried the highest relative risk (RR) of treatment failure (RR = 2.4, P = 0.008), mostly due to discontinuation. Conclusion Iceland is on track to eliminate HCV, but challenges such as increasing drug use in the community and homelessness need to continuously monitored and addressed; they may jeopardize the success of elimination efforts. Disclosures All Authors: No reported Disclosures.

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928. Major Decrease in Prevalence of Hepatitis C Viremia in Key Populations following the Second Year of Treatment as Prevention for Hepatitis C (TraP HepC) Program in Iceland

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy209.069 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S30-S30 ◽

Cited By ~ 1

Author(s):

Magnus Gottfredsson ◽

Thorarinn Tyrfingsson ◽

Valgerdur Runarsdottir ◽

Ingunn Hansdottir ◽

Ottar M Bergmann ◽

...

Keyword(s):

Hepatitis C ◽

Addiction Treatment ◽

Antiviral Agents ◽

Population Level ◽

Drop Out ◽

Treatment As Prevention ◽

Direct Acting Antiviral ◽

Before And After ◽

History Of ◽

The Impact

Abstract Background Hepatitis C Virus (HCV) commonly affects people who inject drugs (PWID) and/or with history of injection drug use (IDU). They are also disproportionately represented in addiction treatment centers and the penitentiary system. In order to curtail spread of HCV it is therefore important to approach these groups. PWID and prisoners have been prioritized in the TraP HepC program. The impact can thus be assessed by monitoring HCV prevalence at sentinel sites, such as addiction hospitals and prisons. Methods TraP HepC offers direct-acting antiviral agents (DAAs) to all HCV patients in Iceland, starting in January 2016. HCV PCR is performed at the end of treatment and 12 weeks later (SVR12). PWID and prisoners are monitored for reinfection and retreated if needed. We compared the prevalence of HCV viremia among PWID admitted for treatment at Vogur addiction hospital and inmates of the penitentiary system, before and after 2 years of TraP HepC. Results Two years into the program 667 patients had been evaluated of which 632 were initiated on their first course of DAAs and 7 were pending, representing 80% of the estimated total patient population. Of those who completed first treatment according to guidelines the SVR12 is 95.5%. Drop-out from first treatment was 8.2%; nevertheless, the SVR12 was >40% and most of the remaining viremic patients completed or are undergoing retreatment. In 2012–2015, prior to TraP HepC the prevalence of HCV viremia among actively injecting PWID admitted for addiction treatment was 47.9%, dropping to 39.8% in 2016 and 16.2% in 2017 (P < 0.001). Likewise, the prevalence of viremia among patients with history of IDU but not recently injecting fell from 27.4% (2012–2015) to 19.8% in 2016 and 4.1% in 2017 (P < 0.001). The prevalence of viremia among inmates of the penitentiary system was 29% prior to initiation of TraP HepC, dropping to 7% in 2017 (P < 0.01). These results are not explained by declining IDU in the community. Conclusion On a population level the domestic transmission of HCV can be reduced by DAAs when combined with other efforts. Two years into the TraP HepC program the prevalence of viremia among two of the most important drivers of the epidemic has been markedly reduced. The program is ongoing, with further emphasis on increased intensity of screening, retreatment and harm reduction. Disclosures All authors: No reported disclosures.

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The natural history of hepatitis C infection acquired through injection drug use: Meta-analysis and meta-regression

Journal of Hepatology ◽

10.1016/j.jhep.2010.03.015 ◽

2010 ◽

Vol 53 (2) ◽

pp. 245-251 ◽

Cited By ~ 35

Author(s):

Ava John-Baptiste ◽

Murray Krahn ◽

Jenny Heathcote ◽

Audery Laporte ◽

George Tomlinson

Keyword(s):

Hepatitis C ◽

Drug Use ◽

Natural History ◽

Injection Drug Use ◽

Meta Analysis ◽

Injection Drug ◽

Hepatitis C Infection ◽

History Of ◽

Meta Regression

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The hepatitis C epidemic in Canada: An overview of recent trends in surveillance, injection drug use, harm reduction and treatment

Canada Communicable Disease Report ◽

10.14745/ccdr.v47i12a01 ◽

2021 ◽

Vol 47 (12) ◽

pp. 505-514

Author(s):

Lillian Lourenço ◽

Marian Kelly ◽

Jill Tarasuk ◽

Kyla Stairs ◽

Maggie Bryson ◽

...

Keyword(s):

Hepatitis C ◽

Drug Use ◽

Harm Reduction ◽

Injection Drug Use ◽

Injection Drug ◽

Health Concern ◽

Prescription Opioid ◽

Direct Acting Antiviral ◽

Life Years ◽

Hcv Transmission

Hepatitis C continues to be a significant public health concern in Canada, with the hepatitis C virus (HCV) responsible for more life-years lost than all other infectious diseases in Canada. An increase in reported hepatitis C infections was observed between 2014 and 2018. Here, we present changing epidemiological trends and discuss risk factors for hepatitis C acquisition in Canada that may have contributed to this increase in reported hepatitis C infections, focusing on injection drug use. We describe a decrease in the use of borrowed needles or syringes coupled with an increase in using other used injection drug use equipment. Also, an increased prevalence of injection drug use and use of prescription opioid and methamphetamine injection by people who inject drugs (PWID) may be increasing the risk of HCV acquisition. At the same time, while harm reduction coverage appears to have increased in Canada in recent years, gaps in access and coverage remain. We also consider how direct-acting antiviral (DAA) eligibility expansion may have affected hepatitis C rates from 2014 to 2018. Finally, we present new surveillance trends observed in 2019 and discuss how the coronavirus disease 2019 (COVID-19) pandemic may affect hepatitis C case counts from 2020 onwards. Continual efforts to i) enhance hepatitis C surveillance and ii) strengthen the reach, effectiveness, and adoption of hepatitis C prevention and treatment services across Canada are vital to reducing HCV transmission among PWID and achieving Canada’s HCV elimination targets by 2030.

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Adherence to Once-daily and Twice-daily Direct-acting Antiviral Therapy for Hepatitis C Infection Among People With Recent Injection Drug Use or Current Opioid Agonist Therapy

Clinical Infectious Diseases ◽

10.1093/cid/ciz1089 ◽

2019 ◽

Vol 71 (7) ◽

pp. e115-e124 ◽

Cited By ~ 6

Author(s):

Evan B Cunningham ◽

Behzad Hajarizadeh ◽

Janaki Amin ◽

Alain H Litwin ◽

Edward Gane ◽

...

Keyword(s):

Hepatitis C ◽

Drug Use ◽

Injection Drug Use ◽

Injection Drug ◽

Agonist Therapy ◽

Opioid Agonist ◽

Once Daily ◽

Direct Acting Antiviral ◽

Opioid Agonist Therapy ◽

Direct Acting

Abstract Background This study investigated adherence and associated factors among people with recent injection drug use (IDU) or current opioid agonist therapy (OAT) and compared once-daily to twice-daily hepatitis C virus (HCV) direct-acting antiviral (DAA) therapy. Methods SIMPLIFY and D3FEAT are international, multicenter studies that recruited participants with recent IDU (previous 6 months; SIMPLIFY, D3FEAT) or current OAT (D3FEAT) between March 2016 and February 2017 in 8 countries. Participants received sofosbuvir/velpatasvir (once daily; SIMPLIFY) or paritaprevir/ritonavir/ombitasvir, dasabuvir (twice daily) ± ribavirin (D3FEAT) for 12 weeks administered in electronic blister packs. We evaluated overall adherence (proportion of prescribed doses taken) and nonadherence (<90% adherent) between dosing patterns. Results Of 190 participants, 184 (97%) completed treatment. Median adherence was 92%, with higher adherence among those receiving once-daily vs twice-daily therapy (94% vs 87%, P = .005). Overall, 40% of participants (n = 76) were nonadherent (<90% adherent). Recent stimulant injecting (odds ratio [OR], 2.48 [95% confidence interval {CI}, 1.28–4.82]), unstable housing (OR, 2.18 [95% CI, 1.01–4.70]), and twice-daily dosing (OR, 2.81 [95% CI, 1.47–5.36]) were associated with nonadherence. Adherence decreased during therapy. Sustained virologic response was high in nonadherent (89%) and adherent populations (95%, P = .174), with no difference in SVR between those who did and did not miss 7 consecutive doses (92% vs 93%, P = .897). Conclusions This study demonstrated high adherence to once- and twice-daily DAA therapy among people with recent IDU or currently receiving OAT. Nonadherence described did not impact treatment outcomes, suggesting forgiveness to nonadherence.

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High hepatitis C virus infection among female sex workers in Viet Nam: strong correlation with HIV and injection drug use

Western Pacific Surveillance and Response ◽

10.5365/wpsar.2019.10.1.002 ◽

2019 ◽

Vol 10 (3) ◽

pp. 9-18

Author(s):

Linh-Vi Le ◽

Siobhan O’Connor ◽

Tram Hong Tran ◽

Lisa Maher ◽

John Kaldor ◽

...

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Drug Use ◽

Injection Drug Use ◽

Sex Workers ◽

Female Sex Workers ◽

Injection Drug ◽

Active Infection ◽

High Prevalence ◽

History Of

Objective: The World Health Organization’s guidelines on viral hepatitis testing and treatment recommend prioritizing high prevalence groups. Hepatitis C virus (HCV) infection disproportionately affects people who inject drugs and men who have sex with men, but data on female sex workers (FSW) are limited. The study aimed to determine active HCV infection and risk factors associated with HCV exposure among Vietnamese FSW. Methods: We surveyed 1886 women aged ≥ 18 years from Haiphong, Hanoi and Ho Chi Minh City who had sold sex in the last month. We tested for HCV antibody and HCV core antigen as markers for exposure to HCV and active infection, respectively. Results: Across these provinces, high prevalence of HCV exposure (8.8–30.4%) and active infection (3.6–22.1%) were observed. Significant associations with HCV exposure were HIV infection (aOR = 23.7; 95% CI: 14.8–37.9), injection drug use (aOR = 23.3; 95% CI: 13.1–41.4), history of compulsory detention (aOR = 2.5; 95% CI: 1.4–4.2) and having more than 10 sex clients in the last month (aOR = 1.9; 95% CI: 1.2–3.2). Among FSW who reported never injecting drugs, HIV infection (aOR = 24.2; 95% CI: 14.8–39.4), a history of non-injection drug use (aOR = 3.3, CI: 1.8–5.7), compulsory detention (aOR = 2.2; 95% CI: 1.2–4.0) and having over 10 sex clients in the last month (aOR = 2.2, 95% CI: 1.3–3.7) were independently associated with HCV exposure. Discussion: FSW have elevated HCV risks through sex- and drug-related pathways. These findings highlight the need to offer FSW-targeted HCV interventions and ensure their access to HIV prevention and treatment.

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Factors Associated with Prevalent Hepatitis C Infection Among HIV-Infected Women with No Reported History of Injection Drug Use: The Women's Interagency HIV Study (WIHS)

AIDS Patient Care and STDs ◽

10.1089/apc.2009.0111 ◽

2009 ◽

Vol 23 (11) ◽

pp. 915-923 ◽

Cited By ~ 36

Author(s):

Toni Frederick ◽

Pamela Burian ◽

Norah Terrault ◽

Mardge Cohen ◽

Michael Augenbraun ◽

...

Keyword(s):

Hepatitis C ◽

Drug Use ◽

Injection Drug Use ◽

Injection Drug ◽

Hepatitis C Infection ◽

Factors Associated ◽

History Of

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Hepatitis C Virus Seroconversion among Hiv-Positive Men Who Have Sex with Men with No History of Injection Drug Use: Results from a Clinical Hiv Cohort

Canadian Journal of Infectious Diseases and Medical Microbiology ◽

10.1155/2015/689671 ◽

2015 ◽

Vol 26 (1) ◽

pp. 17-22 ◽

Cited By ~ 18

Author(s):

Ann N Burchell ◽

Sandra L Gardner ◽

Tony Mazzulli ◽

Michael Manno ◽

Janet Raboud ◽

...

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Drug Use ◽

Injection Drug Use ◽

Injection Drug ◽

Hiv Care ◽

Hiv Positive ◽

History Of ◽

Sex With Men ◽

Hiv Positive Men

BACKGROUND: Internationally, there is a growing recognition that hepatitis C virus (HCV) may be sexually transmitted among HIV-positive men who have sex with men (MSM).OBJECTIVE: To report the first Canadian estimate of HCV seroincidence in 2000 to 2010 and its risk factors among HIV-positive MSM with no known history of injection drug use.METHODS: Data from the Ontario HIV Treatment Network Cohort Study, an ongoing cohort of individuals in HIV care in Ontario, were analyzed. Data were obtained from medical charts, interviews and record linkage with the provincial public health laboratories. The analysis was restricted to 1534 MSM who did not report injection drug use and had undergone ≥2 HCV antibody tests, of which the first was negative (median 6.1 person-years [PY] of follow-up; sum 9987 PY).RESULTS: In 2000 to 2010, 51 HCV seroconversions were observed, an overall incidence of 5.1 per 1000 PY (95% CI 3.9 to 6.7). Annual incidence varied from 1.6 to 8.9 per 1000 PY, with no statistical evidence of a temporal trend. Risk for seroconversion was elevated among men who had ever had syphilis (adjusted HR 2.5 [95% CI 1.1 to 5.5) and men who had acute syphilis infection in the previous 18 months (adjusted HR 2.8 [95% CI 1.0 to 7.9]). Risk was lower for men who had initiated antiretroviral treatment (adjusted HR 0.49 [95% CI 0.25 to 0.95]). There were no statistically significant effects of age, ethnicity, region, CD4 cell count or HIV viral load.CONCLUSIONS: These findings suggest that periodic HCV rescreening may be appropriate in Ontario among HIV-positive MSM. Future research should seek evidence whether syphilis is simply a marker for high-risk sexual behaviour or networks, or whether it potentiates sexual HCV transmission among individuals with HIV.

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