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


Characteristics of People Living With HIV/HCV Coinfection, 1993–2017

Between 1993 and 2017, 988 individuals were identified as living with HIV/HCV coinfection in NSW, Australia (Table 1). Median year of birth was 1966 (IQR 1960–1973), most were male (92%, n = 912) and born in Australia (76%, n = 679). Nine percent (n = 82) identified as Aboriginal and/or Torres Strait Islander. A total of 17% (n = 171) had a history of alcohol-use disorder. Individuals were mostly HCV notified in metropolitan area (68%, n = 657), followed by rural (16%, n = 156) and outer-metropolitan (15%, n = 147) areas. Only 5% (n = 47) had a history of incarceration in DAA era. Further, in DAA era (2016–2018), 61% (n = 598) had no evidence of drug dependence, 20% (n = 200) had evidence of distant drug dependence and 19% (n = 190) had evidence of recent drug dependence.

Overall HCV Cascade of Care Among People Living With HIV/HCV Coinfection (2010–2018)

A total of 383 individuals were alive and HCV notified between 2009 and 2017 (Figure 1). Of this population, 349 (91%) ever received HCV RNA testing and 285 (74%) had an indicator of chronic HCV infection and were eligible for treatment. From the population eligible for treatment, 210 (74%) ever received HCV treatment.

Figure 1.

HCV cascade of care among people living with HIV/HCV coinfection, New South Wales, Australia, 2010–2018. Arrows between bars represent the proportion of patients in each step of the cascade from the patients in the preceding step. For example, 74% of those ever HCV-RNA positive initiated HCV treatment

HCV RNA Testing and HCV Treatment Uptake—Pre-DAA era (2010–2015)

Between 2010 and 2015 (pre-DAA era), a total 286 individuals were alive, and HCV notified, and therefore, could receive HCV RNA testing (Figure 2). Of this population, 244 (85%) received an HCV RNA test in pre-DAA era. A total of 225 individuals had an indicator of chronic HCV infection and were eligible for treatment, of whom 16 (7%) received HCV treatment in pre-DAA era.

Figure 2.

HCV RNA testing and treatment uptake in the pre-DAA era (2010–2015) and post-DAA era (2016–2018), among people living with HCV/HIV coinfection NSW, Australia

HCV RNA Testing and HCV Treatment Uptake—Post-DAA era (2016–2018)

To derive the DAA era population (2016–2018), people who received HCV treatment in pre-DAA era (n = 16) with no subsequent treatment episodes were presumed to have cleared HCV through therapy and were excluded, resulting in 367 individuals; 286 notified in pre-DAA era and 81 in DAA era. Of this population (n = 367), 244 received HCV RNA testing pre-DAA era and 87 in DAA era resulting in 331 (90%) individuals ever receiving HCV RNA testing.

A total of 123 individuals were eligible for first HCV RNA testing in DAA era, including 81 individuals newly HCV notified in DAA era, and 42 individuals notified in pre-DAA era who had never received RNA testing. Of this population (n = 123), 87 (71%) received HCV RNA testing. Among the 81 individuals newly notified in DAA era, 75 (93%) received HCV RNA testing.

A total of 267 individuals had indicators of chronic HCV infection in DAA era, of whom 194 (73%) received HCV treatment.

Time to HCV Treatment Uptake

The median time from HCV RNA testing to HCV treatment uptake is shown in Figure 3, by year 2010 to 2017. Time to treatment uptake decreased from 311 weeks in 2010 to 52 weeks in 2015 (end of pre-DAA era), further declining to four weeks (IQR 0–18) by 2017 (DAA era).

Figure 3.

Median time from HCV testing to HCV treatment initiation among people living with HCV/HIV coinfection in NSW 2010–2017, n = 383

Factors Associated With not Receiving HCV RNA Testing, Ever (2010–2018)

After adjusting, not receiving HCV RNA testing was associated with younger age (adjusted odds ratio [aOR] 0.98; 95% CI 0.96–0.99, p = .023), female gender (aOR 1.87; 95% CI 1.10–3.19, p = .022), and rural region residence at HCV notification (aOR 1.56; 95% CI 1.03–2.36, p = .035) (Table 2).

Factors Associated With not Receiving HCV Treatment in the DAA era (2016–2018)

After adjusting, there were no factors associated with not receiving HCV treatment in the DAA era (Table 3). However, given the small number of untreated individuals in DAA era (n = 68), the sample size was underpowered.