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Abstract
Testing and treatment of Hepatitis C virus (HCV) has undergone rapid development over recent years and, in Australia, access to HCV antiviral treatment is available and unrestricted for all people with the disease. There is potential to drastically reduce the incidence and prevalence of the disease, especially among people who inject drugs (PWID). However, increasing testing and linkage to care must be improved if we are to realise this potential.
The broad aims of this thesis are to examine how identifying the most appropriate settings through which to deliver HCV care might increase the accessibility and acceptability of HCV treatment to PWID. Also, how testing and treatment might impact prevalence. Chapters 3 and 4 examine the utility and potential of opioid substitution treatment (OST) settings, and general practice (GP) settings in delivering HCV care. Chapter 5 describes HCV treatment uptake among a group of PWID, and Chapter 6 examines the association between high-risk injecting practices and self-reported HCV status.
Research questions were embedded into a nation-wide cross-sectional, sentinel-population survey of people who regularly inject drugs. Data was analysed using a variety of descriptive analyses and regression models.
Key Findings: 1) A variety of settings will be required to target a broad group of PWID. Focusing on Addiction Services potentially excludes a large number of PWID. 2) There are significant gaps in service delivery, specifically confirmatory (RNA) testing. 3) Expansion of HCV care to OST clinics and prescribers in addition to community GPs would result in better testing outcomes and these results appear to also carry over to treatment uptake, and 4) Knowledge of HCV infection status appears to influence injecting risk behaviours among PWID.
Despite considerable advances in testing and treatment, challenges in meeting the needs of PWID living with HCV remain. Focusing on Addiction Services and treatment settings where PWID frequent can address some access barriers to care but will potentially miss a large proportion of HCV positive PWID. Mainstream services must also be considered and a wide range of options are required if HCV elimination targets are to be met.