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
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 cr...
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| Format: | Article |
| Language: | English |
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MDPI AG
2024-03-01
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| Series: | Viruses |
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| Online Access: | https://www.mdpi.com/1999-4915/16/3/389 |
| _version_ | 1797239128660639744 |
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| author | Ana Maria Passos-Castilho Donald G. Murphy Karine Blouin Andrea Benedetti Dimitra Panagiotoglou Julie Bruneau Marina B. Klein Jeffrey C. Kwong Beate Sander Naveed Z. Janjua Christina Greenaway |
| author_facet | Ana Maria Passos-Castilho Donald G. Murphy Karine Blouin Andrea Benedetti Dimitra Panagiotoglou Julie Bruneau Marina B. Klein Jeffrey C. Kwong Beate Sander Naveed Z. Janjua Christina Greenaway |
| author_sort | Ana Maria Passos-Castilho |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-24T17:46:37Z |
| format | Article |
| id | doaj.art-d5946aea512640f693b06d0c59bcd669 |
| institution | Directory Open Access Journal |
| issn | 1999-4915 |
| language | English |
| last_indexed | 2024-04-24T17:46:37Z |
| publishDate | 2024-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Viruses |
| spelling | doaj.art-d5946aea512640f693b06d0c59bcd6692024-03-27T14:07:44ZengMDPI AGViruses1999-49152024-03-0116338910.3390/v16030389Ongoing Gaps in the Hepatitis C Care Cascade during the Direct-Acting Antiviral Era in a Large Retrospective Cohort in Canada: A Population-Based StudyAna Maria Passos-Castilho0Donald G. Murphy1Karine Blouin2Andrea Benedetti3Dimitra Panagiotoglou4Julie Bruneau5Marina B. Klein6Jeffrey C. Kwong7Beate Sander8Naveed Z. Janjua9Christina Greenaway10Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC H3T 1E2, CanadaLaboratoire de Santé Publique du Québec, Institut National de Santé Publique du Québec, Sainte-Anne-de-Bellevue, QC H9X 3R5, CanadaUnité sur les Infections Transmissibles Sexuellement et par le Sang, Institut National de Santé Publique du Québec, Québec, QC H9X 3R5, CanadaDepartment of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, QC H3A 1G1, CanadaDepartment of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, QC H3A 1G1, CanadaCHUM Research Centre, Centre Hospitalier de l’Université de Montréal, Montreal, QC H2X 0A9, CanadaResearch Institute of the McGill University Health Centre, Montreal, QC H3H 2R9, CanadaDalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, CanadaICES, Toronto, ON M4N 3M5, CanadaSchool of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, CanadaCentre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC H3T 1E2, CanadaTo 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.https://www.mdpi.com/1999-4915/16/3/389hepatitis Ccare cascadebirth cohortpeople who inject drugsimmigrants |
| spellingShingle | Ana Maria Passos-Castilho Donald G. Murphy Karine Blouin Andrea Benedetti Dimitra Panagiotoglou Julie Bruneau Marina B. Klein Jeffrey C. Kwong Beate Sander Naveed Z. Janjua Christina Greenaway 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 Viruses hepatitis C care cascade birth cohort people who inject drugs immigrants |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | hepatitis C care cascade birth cohort people who inject drugs immigrants |
| url | https://www.mdpi.com/1999-4915/16/3/389 |
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