High Effectiveness of Broad Access Direct‐Acting Antiviral Therapy for Hepatitis C in an Australian Real‐World Cohort: The REACH‐C Study. Issue 3 (2nd November 2021)

• Record Type: Journal Article
• Authors: Yee, Jasmine; Carson, Joanne M.; Hajarizadeh, Behzad; Hanson, Joshua; O'Beirne, James; Iser, David; Read, Phillip; Balcomb, Anne; Doyle, Joseph S.; Davies, Jane; Martinello, Marianne; Marks, Philiipa; Dore, Gregory J.; Matthews, Gail V.
• Other Names: Iser David investigator.; Matthews Gail investigator.; Dore Gregory investigator.; Hanson Josh investigator.; O'Beirne James investigator.; Read Phillip investigator.; Balcomb Anne investigator.; Carson Joanne investigator.; Yee Jasmine investigator.; Marks Philippa investigator.; Yee Jasmine investigator.; Carson Joanne investigator.; Matthews Gail investigator.; Dore Gregory investigator.; Hajarizadeh Behzad investigator.; Byrne Marianne investigator.; Marks Philippa investigator.; Post Jeffery investigator.; Doyle Joseph investigator.; Batey Robert investigator.; Smart John investigator.; Dawson Olivia investigator.; Hill Sonja investigator.; Douglas Mark investigator.; Martinello Marianne investigator.; Montebello Mark investigator.; Collie Patricia investigator.; Hallinan Richard investigator.; Hanson Josh investigator.; Snelgar Gail investigator.; Baker David investigator.; Galhenage Sam investigator.; Soo Tuck Meng investigator.; Read Phillip investigator.; Bopage Rohan investigator.; Faros John investigator.; Cooper Lucy investigator.; Balcomb Anne investigator.; Nelson Renjy investigator.; Shaw David investigator.; Davies Jane investigator.; Wilson Mark investigator.; Iser David investigator.; Pratt William investigator.; Hinton Stephen investigator.; Dore Gregory investigator.; O'Beirne James investigator.; Wade Amanda investigator.; Van Gessel Helen investigator.; Davidson Leonie investigator.; Dibdin Miranda investigator.; Lucas Micaela investigator.; Ahmad Raghib investigator.; Smith Denise investigator.; Tan Khim investigator.; Roder Christine investigator.; Harney Brendan investigator.; Holdaway Susan investigator.; Walsh Jayde investigator.; Fox Penny investigator.; Mousavi Roshanak investigator.; Lam Wendy investigator.; Dahal Rupa Pudasaini investigator.; Habel Philip investigator.; Gilliver Rosie investigator.; Silins Edmund investigator.; Ackerman Jessica investigator.; Deacon Rachel investigator.; Hall Edmund investigator.; Everson Arlene investigator.; Milner Margery investigator.; Ferguson Catherine investigator.; Tate‐Baker Jaclyn investigator.; Bradshaw Jane investigator.; Duncan Gai investigator.; Baluran Gilbert investigator.; Watson Belinda investigator.; Hey Camilla investigator.; Hickey Rebecca investigator.; Orme Clare investigator.; Miczkova Silvie investigator.;
• Is Part Of: Hepatology communications. Volume 6:Issue 3(2022)
• Page Start: 496
• Page End: 512
• Publication Date: 2021-11-02
• Subjects: Hepatology -- Periodicals; Liver -- Diseases -- Periodicals; Liver Diseases; Gastroenterology; Periodicals; Fulltext; Internet Resources; Periodicals; 616.36
• DOI: 10.1002/hep4.1826
• Languages: English
• ISSNs: 2471-254X

Abstract

Abstract : Australia was one of the first countries with unrestricted access to government subsidized direct‐acting antiviral (DAA) therapy for adults with chronic hepatitis C virus. This study assessed real‐world DAA treatment outcomes across a diverse range of Australian clinical services and evaluated factors associated with successful treatment and loss to follow‐up. Real‐world Effectiveness of Antiviral therapy in Chronic Hepatitis C (REACH‐C) consisted a national observational cohort of 96 clinical services including specialist clinics and less traditional settings such as general practice. Data were obtained on consecutive individuals who commenced DAAs from March 2016 to June 2019. Effectiveness was assessed by sustained virological response ≥12 weeks following treatment (SVR) using intention‐to‐treat (ITT) and per‐protocol (PP) analyses. Within REACH‐C, 10, 843 individuals initiated DAAs (male 69%; ≥50 years 52%; cirrhosis 22%). SVR data were available in 85% (9, 174 of 10, 843). SVR was 81% (8, 750 of 10, 843) by ITT and 95% (8, 750 of 9, 174) by PP. High SVR (≥92%) was observed across all service types and participant characteristics. Male gender (adjusted odds ratio [aOR] 0.56, 95% confidence interval [CI] 0.43‐0.72), cirrhosis (aOR 0.52, 95% CI 0.41‐0.64), recent injecting drug use (IDU; aOR 0.64, 95% CI 0.46‐0.91) and previous DAA treatment (aOR 0.50, 95% CI 0.28‐0.90) decreased the likelihood of achieving SVR. Multiple factors modified the likelihood of loss to follow‐up including IDU ± opioid agonist therapy (OAT; IDU only: aOR 1.75, 95% CI 1.44‐2.11; IDU + OAT: aOR 1.39, 95% CI 1.11‐1.74; OAT only, aOR 1.36; 95% CI 1.13‐1.68) and age (aOR 0.97, 95% CI 0.97‐0.98). Conclusion: Treatment response was high in a diverse population and through a broad range of services following universal access to DAA therapy. Loss to follow‐up presents a real‐world challenge. Younger people who inject drugs were more likely to disengage from care, requiring innovative strategies to retain them in follow‐up. Abstract : image