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Abstract
Background: Hepatitis C virus (HCV)-related morbidity and mortality are rising. Despite recent therapeutic advances, HCV assessment and treatment uptake remains suboptimal, particularly among people who inject drugs (PWID).
Aims: The broad aim of this research was to inform barriers to the assessment and treatment of HCV infection among PWID. Specific aims included evaluation of mortality and life expectancy among people with chronic HCV infection; evaluation of HCV treatment uptake and associated factors among inner city residents; evaluation of HCV assessment and treatment uptake among PWID in opioid substitution setting; evaluation of willingness to receive HCV treatment among PWID; and evaluation of the impact of treatment for HCV infection on depression and mental health parameters.
Methods: In Chapter Two, data from a population-based linkage study were analysed, using a competing risk methodology for calculation of mortality rates and life expectancy. In Chapter Three, data from the Community Health and Safety Evaluation (CHASE) cohort were analysed, using person-time and logistic regression methods. In Chapters Four and Five, data from the Enhancing Treatment for Hepatitis C in Opioid Substitution Settings (ETHOS) study were analysed, using logistic regression. In Chapter Six, data from the Australian Trial in Acute Hepatitis C (ATAHC) study were analysed, using logistic regression.
Key Findings: Among people with an HCV notification, liver-related mortality is increasing. Life expectancy in this population is considerably lower, compared to the general population. Over the last decade, HCV treatment uptake has slightly increased yet remained suboptimal. Integration of HCV care within existing infrastructures for addiction care is successful in increasing HCV assessment and treatment uptake among PWID. Despite low HCV treatment uptake, treatment willingness is high among PWID and predicts subsequent assessment and treatment. PWID with poor social functioning may be most at risk of developing depression during HCV therapy. However, depression prior to or during treatment does not have an impact on sustained virological response.
Conclusion: Strategic public health planning is needed to lower the rising HCV disease burden. Barriers to HCV assessment and treatment among PWID are complex and require a multidimensional approach. Multidisciplinary partnerships are needed to expand access to HCV services.