Evaluation of the Hepatitis C Cascade of Care Among People Living With HIV in New South Wales, Australia

A Data Linkage Study

Samira Hosseini-Hooshyar; Maryam Alavi; Marianne Martinello; Heather Valerio; Shane Tillakeratne; Gail V. Matthews; Gregory J. Dore


J Viral Hepat. 2022;29(4):271-279. 

In This Article

Abstract and Introduction


People living with HIV (PLHIV) are a priority population to receive hepatitis C virus (HCV) screening and treatment. We aimed to characterize the HCV care cascade among PLHIV between 2010 and 2018 and to compare HCV testing and treatment uptake pre- and post-availability of direct-acting antivirals (DAAs) in New South Wales (NSW), Australia. Records of all HCV notifications (1993–2017) were linked to HIV notifications, deaths, hospitalizations, incarcerations, opioid agonist therapy, HCV RNA testing and treatment databases. Numbers and proportions were calculated for all stages of the care cascade and factors associated with HCV testing, and DAA treatment uptake were evaluated using logistic regression. From 383 individuals with HCV notification (2009–2017), 349 (91%) were ever HCV RNA tested, 285 (74%) had an indicator of chronic HCV infection, and from those eligible for treatment, 210 (74%) received HCV treatment. HCV testing was recorded for 85% pre-DAA era and reached a cumulative proportion of 90% post-DAA while treatment uptake had a 10-fold increase from 7% pre- to 73% post-DAA era. Younger age (adjusted odds ratio [aOR] 0.98; 95% CI 0.96–0.99), female gender (aOR 1.87; 95% CI 1.10–3.19), and rural region residence at notification (aOR 1.56; 95% CI 1.03–2.36) were associated with not receiving HCV testing. No identified factor was associated with not receiving treatment post-DAA era. Removing barriers to HCV testing, expanding treatment to a variety of settings and continuous education and harm reduction are essential to achieve HCV elimination among PLHIV in Australia.


An estimated 2.3 million people worldwide are living with HIV/hepatitis C virus (HCV) coinfection.[1] Consequences of HCV infection are more severe among people living with HIV (PLHIV) including increased risk of cirrhosis, hepatic failure and hepatocellular carcinoma.[2,3] Further, liver-related mortality has become one of the most frequent causes of death among PLHIV who have access to combination antiretroviral therapy.[4] PLHIV have therefore been identified as a priority population to receive HCV screening and treatment,[5] in efforts to meet the World Health Organization (WHO) HCV elimination targets. These targets include diagnosing 90% of people living with HCV infection and treating 80% of those diagnosed by 2030.[6] Accordingly, for Australia to achieve the WHO HCV elimination goals, improvements in diagnosis and treatment of HCV PLHIV are essential.

Treatment for HCV has undergone tremendous changes from a period of moderately effective interferon-based treatments to highly effective direct-acting antiviral (DAA) therapies. In the DAA era, people living with HIV/HCV coinfection tend to achieve high sustained virological response (SVR; ≥95%) rates, comparable to those obtained among HCV mono-infected individuals.[7,8] In Australia, government-subsidized DAA therapy has been available since March 2016 for all adults with HCV infection, including PLHIV.[9,10] Unrestricted access to DAA therapy, at no or minimal cost to the individual, has facilitated rapid HCV treatment scale-up among PLHIV.[11,12] However, for treatment scale-up to continue having a great impact, screening efforts must reach undiagnosed individuals, and new diagnoses must be linked with care and treatment.[13]

To assess progress towards WHO HCV elimination targets, monitoring HCV-infected individuals across the care continuum or cascade of care is imperative.[14] An evaluation of the current HCV care cascade can provide a useful benchmark for tracking the effectiveness of programs and interventions and identify the service and access gaps at a broad population level.[15] The objectives of this study were to characterize the HCV care cascade among PLHIV in New South Wales (NSW), Australia, between 2010 and 2018, and to compare HCV RNA testing and HCV treatment uptake among PLHIV pre- (2010–2015) and post-introduction (2016–2018) of DAAs in Australia. A further objective was to evaluate factors associated with not receiving HCV RNA testing and DAA treatment uptake among PLHIV in NSW, Australia.