Hepatitis C treatment outcomes for Australian First Nations Peoples: equivalent SVR rate but higher rates of loss to follow-up
Abstract Background First Nations Peoples of Australia are disproportionally affected by hepatitis C (HCV) infection. Through a prospective study we evaluated the outcome of direct-acting antiviral (DAA) therapy among First Nations Peoples with HCV infection. Methods Adults who initiated DAA therapy...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-07-01
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| Series: | BMC Gastroenterology |
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| Online Access: | https://doi.org/10.1186/s12876-022-02416-5 |
| _version_ | 1818517797778489344 |
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| author | Paul J. Clark Patricia C. Valery James Ward Simone I. Strasser Martin Weltman Alexander Thompson Miriam T. Levy Barbara Leggett Amany Zekry Julian Rong Peter Angus Jacob George Steven Bollipo Bruce McGarity William Sievert Gerry Macquillan Edmund Tse Amanda Nicoll Amanda Wade Geoff Chu Damian Harding Wendy Cheng Geoff Farrell Stuart K. Roberts |
| author_facet | Paul J. Clark Patricia C. Valery James Ward Simone I. Strasser Martin Weltman Alexander Thompson Miriam T. Levy Barbara Leggett Amany Zekry Julian Rong Peter Angus Jacob George Steven Bollipo Bruce McGarity William Sievert Gerry Macquillan Edmund Tse Amanda Nicoll Amanda Wade Geoff Chu Damian Harding Wendy Cheng Geoff Farrell Stuart K. Roberts |
| author_sort | Paul J. Clark |
| collection | DOAJ |
| description | Abstract Background First Nations Peoples of Australia are disproportionally affected by hepatitis C (HCV) infection. Through a prospective study we evaluated the outcome of direct-acting antiviral (DAA) therapy among First Nations Peoples with HCV infection. Methods Adults who initiated DAA therapy at one of 26 hospitals across Australia, 2016–2019 were included in the study. Clinical data were obtained from medical records and the Pharmaceutical and Medicare Benefits Schemes. Outcomes included sustained virologic response (SVR) and loss to follow-up (LTFU). A multivariable analysis assessed factors associated with LTFU. Results Compared to non-Indigenous Australians (n = 3206), First Nations Peoples (n = 89) were younger (p < 0.001), morel likely to reside in most disadvantaged (p = 0.002) and in regional/remote areas (p < 0.001), and had similar liver disease severity. Medicines for mental health conditions were most commonly dispensed among First Nations Peoples (55.2% vs. 42.8%; p = 0.022). Of 2910 patients with follow-up data, both groups had high SVR rates (95.3% of First Nations Peoples vs. 93.2% of non-Indigenous patients; p = 0.51) and ‘good’ adherence (90.0% vs. 86.9%, respectively; p = 0.43). However, 28.1% of First Nations Peoples were LTFU vs. 11.2% of non-Indigenous patients (p < 0.001). Among First Nations Peoples, younger age (adj-OR = 0.93, 95% CI 0.87–0.99) and treatment initiation in 2018–2019 vs. 2016 (adj-OR = 5.14, 95% CI 1.23–21.36) predicted LTFU, while higher fibrosis score was associated with better engagement in HCV care (adj-OR = 0.71, 95% CI 0.50–0.99). Conclusions Our data showed that First Nations Peoples have an equivalent HCV cure rate, but higher rates of LTFU. Better strategies to increase engagement of First Nations Peoples with HCV care are needed. |
| first_indexed | 2024-12-11T01:01:10Z |
| format | Article |
| id | doaj.art-c756cff2c64949afbd083b0f41c57a38 |
| institution | Directory Open Access Journal |
| issn | 1471-230X |
| language | English |
| last_indexed | 2024-12-11T01:01:10Z |
| publishDate | 2022-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Gastroenterology |
| spelling | doaj.art-c756cff2c64949afbd083b0f41c57a382022-12-22T01:26:20ZengBMCBMC Gastroenterology1471-230X2022-07-0122111010.1186/s12876-022-02416-5Hepatitis C treatment outcomes for Australian First Nations Peoples: equivalent SVR rate but higher rates of loss to follow-upPaul J. Clark0Patricia C. Valery1James Ward2Simone I. Strasser3Martin Weltman4Alexander Thompson5Miriam T. Levy6Barbara Leggett7Amany Zekry8Julian Rong9Peter Angus10Jacob George11Steven Bollipo12Bruce McGarity13William Sievert14Gerry Macquillan15Edmund Tse16Amanda Nicoll17Amanda Wade18Geoff Chu19Damian Harding20Wendy Cheng21Geoff Farrell22Stuart K. Roberts23Department of Gastroenterology, Mater Hospital BrisbaneQIMR Berghofer Medical Research Institute, Faculty of Medicine, The University of QueenslandUQ Poche Centre for Indigenous Health, Faculty of Health and Behavioural Sciences, The University of QueenslandAW Morrow Gastroenterology and Liver Centre Royal Prince Alfred Hospital, University of SydneyHepatology Services, Nepean HospitalDepartment of Gastroenterology, St Vincent’s HospitalDepartment of Gastroenterology and Liver, Liverpool HospitalDepartment of Gastroenterology and Hepatology, Royal Brisbane and Women’s HospitalDepartment of Gastroenterology and Hepatology, St George HospitalGippsland Gastroenterology, Latrobe Regional HospitalDepartment of Gastroenterology and Hepatology, Austin HospitalStorr Liver Unit, Westmead HospitalGastroenterology Department, John Hunter HospitalBathurst Liver Clinic Bathurst HospitalGastrointestinal and Liver Unit, Monash HealthLiver Transplant Unit Sir Charles Gairdner HospitalHepatology, Royal Adelaide HospitalEastern Health BoxBarwon Health Liver Clinic University HospitalOrange Liver Clinic, Orange HospitalDepartment of Gastroenterology and Hepatology, Lyell McEwin HospitalDepartment of Gastroenterology and Hepatology, Royal Perth HospitalGastroenterology and Hepatology Unit Canberra HospitalThe Alfred HospitalAbstract Background First Nations Peoples of Australia are disproportionally affected by hepatitis C (HCV) infection. Through a prospective study we evaluated the outcome of direct-acting antiviral (DAA) therapy among First Nations Peoples with HCV infection. Methods Adults who initiated DAA therapy at one of 26 hospitals across Australia, 2016–2019 were included in the study. Clinical data were obtained from medical records and the Pharmaceutical and Medicare Benefits Schemes. Outcomes included sustained virologic response (SVR) and loss to follow-up (LTFU). A multivariable analysis assessed factors associated with LTFU. Results Compared to non-Indigenous Australians (n = 3206), First Nations Peoples (n = 89) were younger (p < 0.001), morel likely to reside in most disadvantaged (p = 0.002) and in regional/remote areas (p < 0.001), and had similar liver disease severity. Medicines for mental health conditions were most commonly dispensed among First Nations Peoples (55.2% vs. 42.8%; p = 0.022). Of 2910 patients with follow-up data, both groups had high SVR rates (95.3% of First Nations Peoples vs. 93.2% of non-Indigenous patients; p = 0.51) and ‘good’ adherence (90.0% vs. 86.9%, respectively; p = 0.43). However, 28.1% of First Nations Peoples were LTFU vs. 11.2% of non-Indigenous patients (p < 0.001). Among First Nations Peoples, younger age (adj-OR = 0.93, 95% CI 0.87–0.99) and treatment initiation in 2018–2019 vs. 2016 (adj-OR = 5.14, 95% CI 1.23–21.36) predicted LTFU, while higher fibrosis score was associated with better engagement in HCV care (adj-OR = 0.71, 95% CI 0.50–0.99). Conclusions Our data showed that First Nations Peoples have an equivalent HCV cure rate, but higher rates of LTFU. Better strategies to increase engagement of First Nations Peoples with HCV care are needed.https://doi.org/10.1186/s12876-022-02416-5Sustained viral responseLiver fibrosisData linkageLoss to follow-up |
| spellingShingle | Paul J. Clark Patricia C. Valery James Ward Simone I. Strasser Martin Weltman Alexander Thompson Miriam T. Levy Barbara Leggett Amany Zekry Julian Rong Peter Angus Jacob George Steven Bollipo Bruce McGarity William Sievert Gerry Macquillan Edmund Tse Amanda Nicoll Amanda Wade Geoff Chu Damian Harding Wendy Cheng Geoff Farrell Stuart K. Roberts Hepatitis C treatment outcomes for Australian First Nations Peoples: equivalent SVR rate but higher rates of loss to follow-up BMC Gastroenterology Sustained viral response Liver fibrosis Data linkage Loss to follow-up |
| title | Hepatitis C treatment outcomes for Australian First Nations Peoples: equivalent SVR rate but higher rates of loss to follow-up |
| title_full | Hepatitis C treatment outcomes for Australian First Nations Peoples: equivalent SVR rate but higher rates of loss to follow-up |
| title_fullStr | Hepatitis C treatment outcomes for Australian First Nations Peoples: equivalent SVR rate but higher rates of loss to follow-up |
| title_full_unstemmed | Hepatitis C treatment outcomes for Australian First Nations Peoples: equivalent SVR rate but higher rates of loss to follow-up |
| title_short | Hepatitis C treatment outcomes for Australian First Nations Peoples: equivalent SVR rate but higher rates of loss to follow-up |
| title_sort | hepatitis c treatment outcomes for australian first nations peoples equivalent svr rate but higher rates of loss to follow up |
| topic | Sustained viral response Liver fibrosis Data linkage Loss to follow-up |
| url | https://doi.org/10.1186/s12876-022-02416-5 |
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