Supplemental material, sj-pdf-1-tam-10.1177_1758835921992987 for Elevated risk of colorectal, liv... more Supplemental material, sj-pdf-1-tam-10.1177_1758835921992987 for Elevated risk of colorectal, liver, and pancreatic cancers among HCV, HBV and/or HIV (co)infected individuals in a population based cohort in Canada by Maryam Darvishian, Zahid A. Butt, Stanley Wong, Eric M. Yoshida, Jaskaran Khinda, Michael Otterstatter, Amanda Yu, Mawuena Binka, Carmine Rossi, Geoff McKee, Margo Pearce, Maria Alvarez, Jason Wong, Darrel Cook, Troy Grennan, Jane Buxton, Mark Tyndall, Ryan Woods, Mel Krajden, Parveen Bhatti and Naveed Z. Janjua in Therapeutic Advances in Medical Oncology
Public health measures introduced to limit transmission of severe acute respiratory syndrome coro... more Public health measures introduced to limit transmission of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), which causes coronavirus disease 2019 (COVID‐19), also disrupted various healthcare services in many regions worldwide, including British Columbia (BC), Canada. We assessed the impact of these measures, first introduced in BC in March 2020, on hepatitis C (HCV) testing and first‐time HCV‐positive diagnoses within the province.
ABSTRACTIntroductionSeveral non-pharmaceutical interventions such as physical distancing, hand wa... more ABSTRACTIntroductionSeveral non-pharmaceutical interventions such as physical distancing, hand washing, self-isolation, and schools and business closures, were implemented in British Columbia (BC) following the first laboratory-confirmed case of coronavirus disease 2019 (COVID-19) on January 26, 2020, to minimize in-person contacts that could spread infections. The BC COVID-19 Population Mixing Patterns survey (BC-Mix) was established as a surveillance system to measure behaviour and contact patterns in BC over time to inform the timing of the easing/re-imposition of control measures. In this paper, we describe the BC-Mix survey design and the demographic characteristics of respondents.MethodsThe ongoing repeated online survey was launched in September 2020. Participants are mainly recruited through social media platforms (including Instagram, Facebook, YouTube, WhatsApp). A follow up survey is sent to participants two to four weeks after completing the baseline survey. Survey respo...
Background Women living with hepatitis C virus (HCV) are rarely addressed in research and may be ... more Background Women living with hepatitis C virus (HCV) are rarely addressed in research and may be overrepresented within key populations requiring additional support to access HCV care and treatment. We constructed the HCV care cascade among people diagnosed with HCV in British Columbia, Canada, as of 2019 to compare progress in care and treatment and to assess sex/gender gaps in HCV treatment access. Methods The BC Hepatitis Testers Cohort includes 1.7 million people who tested for HCV, HIV, reported cases of hepatitis B, and active tuberculosis in BC from 2000 to 2019. Test results were linked to medical visits, hospitalizations, cancers, prescription drugs, and mortality data. Six HCV care cascade stages were identified: (1) antibody diagnosed; (2) RNA tested; (3) RNA positive; (4) genotyped; (5) initiated treatment; and (6) achieved sustained virologic response (SVR). HCV care cascade results were assessed for women, and an ‘inverse’ cascade was created to assess gaps, including ...
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial ... more This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
We evaluated the effect of sustained virologic response (SVR) from direct-acting antiviral (DAA)-... more We evaluated the effect of sustained virologic response (SVR) from direct-acting antiviral (DAA)-and interferon-based treatments on hepatocellular carcinoma (HCC) risk in a large population-based cohort in Canada. We used data from the BC Hepatitis Testers Cohort, which includes ~1.3 million individuals tested for HCV since 1990, linked with healthcare administrative and registry datasets. Patients were followed from the end of HCV treatment to HCC, death or 31 December 2016. We assessed HCC risk among those who did and did not achieve SVR by treatment type using proportional hazard models. Of 12 776 eligible individuals, 3905 received DAAs while 8871 received interferon-based treatments, followed for a median of 1.0 [range: 0.6-2.7] and 7.9 [range: 4.4-17.1] years, respectively. A total of 3613 and 6575 achieved SVR with DAAs-and interferon-based treatments, respectively. Among DAAstreated patients, HCC incidence rate was 6.9 (95%CI: 4.7-10.1)/1000 person yr (PY) in SVR group (HCC cases: 26) and 38.2 (95%CI: 20.6-71.0) in the no-SVR group (HCC cases: 10, P < .001). Among interferon-treated individuals, HCC incidence rate was 1.8 (95%CI: 1.5-2.2) in the SVR (HCC cases: 99) and 13.9 (95%CI: 12.3-15.8) in the no-SVR group (HCC cases: 239, P < .001). Compared with no-SVR from interferon, SVR from DAA-and interferon-based treatments resulted in significant reduction in HCC risk (adjusted subdistribution hazard ratio (adjSHR) DAA = 0.30, 95%CI: 0.19-0.48 and adjSHR interferon = 0.2, 95%CI: 0.16-0.26). Among those with SVR, treatment with DAAs compared to interferon was not associated with HCC risk (adjSHR = 0.93, 95%CI: 0.51-1.71). In conclusion, similar to interferon era, DAA-related SVR is associated with 70% reduction in HCC risk.
BACKGROUND & AIMS Hepatitis C virus (HCV) infection is associated with several extrahepatic m... more BACKGROUND & AIMS Hepatitis C virus (HCV) infection is associated with several extrahepatic manifestations (EHMs). We evaluated the impact of sustained virologic response (SVR) on the risk of seven EHMs contributing to the burden of extrahepatic disease: type II diabetes mellitus (T2DM), chronic kidney disease (CKD) or end-stage renal disease (ESRD), stroke, ischemic heart disease (IHD), major adverse cardiac events (MACE), mood and anxiety disorders, and rheumatoid arthritis (RA). METHODS A longitudinal cohort study was conducted using data from the British Columbia Hepatitis Testers Cohort, which included ∼1.3 million individuals screened for HCV. We identified all HCV-infected individuals who were treated with interferon-based therapies between 1999/04/01 and 2014/07/01. SVR was defined as a negative HCV RNA test ≥ 24 weeks post-treatment or after end-of-treatment, if unavailable. We computed adjusted subdistribution hazard ratios (asHR) for the effect of SVR on each EHM using competing risk proportional hazard models. Subgroup analysis by birth cohort, sex, injection drug exposure and genotype was also performed. RESULTS Overall, 10,264 HCV-infected individuals were treated with interferon, of whom 6,023 (59%) achieved SVR. As compared to those that failed treatment, EHM risk was significantly reduced among SVR patients for T2DM (asHR, 0.65; 95% confidence interval [CI], 0.55-0.77), CKD or ESRD (asHR, 0.53; 95%CI, 0.43-0.65), ischemic or hemorrhagic stroke (asHR, 0.73; 95%CI, 0.49-1.09), and mood and anxiety disorders (asHR, 0.82; 95%CI, 0.71-0.95), but not for IHD (asHR, 1.23; 95%CI, 1.03-1.47), MACE (asHR: 0.93; 95%CI: 0.79-1.11) or RA (asHR, 1.09; 95% CI, 0.73-1.64). CONCLUSIONS SVR was associated with a reduction in the risk of several EHMs. Increased uptake of antiviral therapy may reduce the growing burden of EHMs in this population. LAY SUMMARY We estimated rates of chronic comorbidities other than liver disease between those who were cured and those failed HCV treatment. Our findings showed that rates of these non-liver disease were largely reduced for those who were cured with interferon-based HCV treatments. Early HCV treatments could provide many benefits in prevention of various HCV complications beyond liver disease.
completed the cases as per standard of care. The primary end point was selection of an optimum tr... more completed the cases as per standard of care. The primary end point was selection of an optimum treatment regimen as per national guidelines. Secondary end points included time to completion, detection of drug-drug interactions and identification of patient interventions. T-test analysis was completed to assess variation in results between groups. Results: A total of 56 cases were completed per group. Use of the toolkit was associated with selection of an optimum treatment regimen in 92.9% of cases as compared with 60.7% of cases in group B (p < 0.05). Drug-drug interaction detection rates were significantly higher with toolkit use (75% vs 47%;p < 0.05). Participants utilising the toolkit suggested an average of 3.4 interventions per case versus 2 per case in Group B. The toolkit was associated with a longer median time to completion (20 versus 15 minutes), however this was not found to be statistically significant (p:0.060). Conclusion: Study findings confirm the effectiveness of the toolkit in aiding pharmacists in selecting the optimum Hepatitis C treatment regimen. The potential for pharmacists working in all practice environments in Ireland, including community, to make a robust contribution to treatment of Hepatitis C, is something that can be supported using this toolkit. This type of capacity building within our limited healthcare resources is key to upscaling the model of care in Ireland to achieve elimination targets.
To describe the characteristics of people diagnosed with acute and chronic hepatitis B virus (HBV... more To describe the characteristics of people diagnosed with acute and chronic hepatitis B virus (HBV) infection in British Columbia (BC). We used data from the BC Hepatitis Testers Cohort (BC-HTC), which includes all individuals tested for hepatitis C virus (HCV) or human immunodeficiency virus (HIV) or those diagnosed with HBV or active tuberculosis in BC since 1990. These data were integrated with prescription drug, medical visit, hospitalization and mortality data. HBV cases were classified as acute or chronic according to provincial guidelines. We compared characteristics of individuals by HBV infection group (acute, chronic and negative). Factors associated with acute or chronic HBV infection were assessed with multinomial logistic regression models in comparison to the HBV negative group. 46498 of the 1058056 eligible BC-HTC participants were diagnosed with HBV infection. 4.3% of HBV positive individuals were diagnosed with acute HBV infections while 95.7% had chronic infections....
Co-occurrence of social conditions and infections may affect HIV/HCV disease risk and progression... more Co-occurrence of social conditions and infections may affect HIV/HCV disease risk and progression. We examined the changes in relationship of these social conditions and infections on HIV and hepatitis C virus (HCV) infections over time in British Columbia during 1990-2013. The BC Hepatitis Testers Cohort (BC-HTC) includes ~1.5 million individuals tested for HIV or HCV, or reported as a case of HCV, HIV, HBV, or tuberculosis linked to administrative healthcare databases. We classified HCV and HIV infection status into five combinations: HIV-/HCV-, HIV+monoinfected, HIV-/HCV+seroconverters, HIV-/HCV+prevalent, and HIV+/HCV+. Of 1.37 million eligible individuals, 4.1% were HIV-/HCV+prevalent, 0.5% HIV+monoinfected, 0.3% HIV+/HCV+ co-infected and 0.5% HIV-/HCV+seroconverters. Overall, HIV+monoinfected individuals lived in urban areas (92%), had low injection drug use (IDU) (4%), problematic alcohol use (4%) and were materially more privileged than other groups. HIV+/HCV+ co-infected an...
Background: Population-level monitoring of hepatitis C virus (HCV) infected people across the cas... more Background: Population-level monitoring of hepatitis C virus (HCV) infected people across the cascade of care identifies gaps in access and engagement in care and treatment. We characterized a population-level cascade of care for HCV in British Columbia (BC), Canada and identified factors associated with leakage at each stage. Methods: The BC Hepatitis Testers Cohort (BC-HTC) includes 1.5 million individuals tested for HCV, HIV, reported cases of hepatitis B, and active tuberculosis in BC from 1990 to 2013 linked to medical visits, hospitalizations, cancers, prescription drugs and mortality data. We defined six HCV cascade of care stages: 1) estimated population prevalence; 2) HCV diagnosed; 3) HCV RNA tested; 4) genotyped; 5) initiated treatment; and 6) achieved sustained virologic response (SVR). Results: We estimated that 73,203 people were HCV antibody positive in BC in 2012 (undiagnosed: 18,301, 25%; diagnosed: 54,902, 75%). Of these, 56%(40,656) had HCV RNA testing; 34%(26,300) were genotyped; 12%(8532) had received interferon-based therapy and 7%(5197) had SVR. Males, older birth cohorts, and HBV coinfected were less likely to undergo HCV RNA testing. Among those with chronic HCV infection, 32% had received liverrelated care. Retention in liver care was more likely in those with HIV, cirrhosis, and drug/alcohol use and less likely in males and HBV coinfected. Conclusions: Although there are gaps in HCV RNA testing and genotyping after HCV diagnosis, the major gap in the cascade of care was low treatment initiation. People with comorbidities progressed through the cascade of testing and care but few received treatment.
Direct-acting antiviral therapies (DAA) are an important tool for hepatitis C virus (HCV) elimina... more Direct-acting antiviral therapies (DAA) are an important tool for hepatitis C virus (HCV) elimination. However, reinfection among people who inject drugs (PWID) may hamper elimination targets. Therefore, we estimated HCV reinfection rates among DAA-treated individuals, including PWID. We analyzed data from the British Columbia Hepatitis Testers Cohort which included ∼1.7 million individuals screened for HCV in British Columbia, Canada. We followed HCV-infected individuals treated with DAAs who achieved a sustained virologic response (SVR) and had ≥1 subsequent HCV RNA measurement to April 22nd, 2018. Reinfection was defined as a positive RNA measurement after SVR. PWID were identified using a validated algorithm and classified based on recent (<3 years) or former (≥3 years before SVR) use. Crude reinfection rates per 100 person-years (PYs) were calculated. Poisson regression was used to model adjusted incidence rate ratios (IRRs) and 95% CIs. Of 4,114 individuals who met the incl...
Supplemental material, sj-pdf-1-tam-10.1177_1758835921992987 for Elevated risk of colorectal, liv... more Supplemental material, sj-pdf-1-tam-10.1177_1758835921992987 for Elevated risk of colorectal, liver, and pancreatic cancers among HCV, HBV and/or HIV (co)infected individuals in a population based cohort in Canada by Maryam Darvishian, Zahid A. Butt, Stanley Wong, Eric M. Yoshida, Jaskaran Khinda, Michael Otterstatter, Amanda Yu, Mawuena Binka, Carmine Rossi, Geoff McKee, Margo Pearce, Maria Alvarez, Jason Wong, Darrel Cook, Troy Grennan, Jane Buxton, Mark Tyndall, Ryan Woods, Mel Krajden, Parveen Bhatti and Naveed Z. Janjua in Therapeutic Advances in Medical Oncology
Public health measures introduced to limit transmission of severe acute respiratory syndrome coro... more Public health measures introduced to limit transmission of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), which causes coronavirus disease 2019 (COVID‐19), also disrupted various healthcare services in many regions worldwide, including British Columbia (BC), Canada. We assessed the impact of these measures, first introduced in BC in March 2020, on hepatitis C (HCV) testing and first‐time HCV‐positive diagnoses within the province.
ABSTRACTIntroductionSeveral non-pharmaceutical interventions such as physical distancing, hand wa... more ABSTRACTIntroductionSeveral non-pharmaceutical interventions such as physical distancing, hand washing, self-isolation, and schools and business closures, were implemented in British Columbia (BC) following the first laboratory-confirmed case of coronavirus disease 2019 (COVID-19) on January 26, 2020, to minimize in-person contacts that could spread infections. The BC COVID-19 Population Mixing Patterns survey (BC-Mix) was established as a surveillance system to measure behaviour and contact patterns in BC over time to inform the timing of the easing/re-imposition of control measures. In this paper, we describe the BC-Mix survey design and the demographic characteristics of respondents.MethodsThe ongoing repeated online survey was launched in September 2020. Participants are mainly recruited through social media platforms (including Instagram, Facebook, YouTube, WhatsApp). A follow up survey is sent to participants two to four weeks after completing the baseline survey. Survey respo...
Background Women living with hepatitis C virus (HCV) are rarely addressed in research and may be ... more Background Women living with hepatitis C virus (HCV) are rarely addressed in research and may be overrepresented within key populations requiring additional support to access HCV care and treatment. We constructed the HCV care cascade among people diagnosed with HCV in British Columbia, Canada, as of 2019 to compare progress in care and treatment and to assess sex/gender gaps in HCV treatment access. Methods The BC Hepatitis Testers Cohort includes 1.7 million people who tested for HCV, HIV, reported cases of hepatitis B, and active tuberculosis in BC from 2000 to 2019. Test results were linked to medical visits, hospitalizations, cancers, prescription drugs, and mortality data. Six HCV care cascade stages were identified: (1) antibody diagnosed; (2) RNA tested; (3) RNA positive; (4) genotyped; (5) initiated treatment; and (6) achieved sustained virologic response (SVR). HCV care cascade results were assessed for women, and an ‘inverse’ cascade was created to assess gaps, including ...
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial ... more This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
We evaluated the effect of sustained virologic response (SVR) from direct-acting antiviral (DAA)-... more We evaluated the effect of sustained virologic response (SVR) from direct-acting antiviral (DAA)-and interferon-based treatments on hepatocellular carcinoma (HCC) risk in a large population-based cohort in Canada. We used data from the BC Hepatitis Testers Cohort, which includes ~1.3 million individuals tested for HCV since 1990, linked with healthcare administrative and registry datasets. Patients were followed from the end of HCV treatment to HCC, death or 31 December 2016. We assessed HCC risk among those who did and did not achieve SVR by treatment type using proportional hazard models. Of 12 776 eligible individuals, 3905 received DAAs while 8871 received interferon-based treatments, followed for a median of 1.0 [range: 0.6-2.7] and 7.9 [range: 4.4-17.1] years, respectively. A total of 3613 and 6575 achieved SVR with DAAs-and interferon-based treatments, respectively. Among DAAstreated patients, HCC incidence rate was 6.9 (95%CI: 4.7-10.1)/1000 person yr (PY) in SVR group (HCC cases: 26) and 38.2 (95%CI: 20.6-71.0) in the no-SVR group (HCC cases: 10, P < .001). Among interferon-treated individuals, HCC incidence rate was 1.8 (95%CI: 1.5-2.2) in the SVR (HCC cases: 99) and 13.9 (95%CI: 12.3-15.8) in the no-SVR group (HCC cases: 239, P < .001). Compared with no-SVR from interferon, SVR from DAA-and interferon-based treatments resulted in significant reduction in HCC risk (adjusted subdistribution hazard ratio (adjSHR) DAA = 0.30, 95%CI: 0.19-0.48 and adjSHR interferon = 0.2, 95%CI: 0.16-0.26). Among those with SVR, treatment with DAAs compared to interferon was not associated with HCC risk (adjSHR = 0.93, 95%CI: 0.51-1.71). In conclusion, similar to interferon era, DAA-related SVR is associated with 70% reduction in HCC risk.
BACKGROUND & AIMS Hepatitis C virus (HCV) infection is associated with several extrahepatic m... more BACKGROUND & AIMS Hepatitis C virus (HCV) infection is associated with several extrahepatic manifestations (EHMs). We evaluated the impact of sustained virologic response (SVR) on the risk of seven EHMs contributing to the burden of extrahepatic disease: type II diabetes mellitus (T2DM), chronic kidney disease (CKD) or end-stage renal disease (ESRD), stroke, ischemic heart disease (IHD), major adverse cardiac events (MACE), mood and anxiety disorders, and rheumatoid arthritis (RA). METHODS A longitudinal cohort study was conducted using data from the British Columbia Hepatitis Testers Cohort, which included ∼1.3 million individuals screened for HCV. We identified all HCV-infected individuals who were treated with interferon-based therapies between 1999/04/01 and 2014/07/01. SVR was defined as a negative HCV RNA test ≥ 24 weeks post-treatment or after end-of-treatment, if unavailable. We computed adjusted subdistribution hazard ratios (asHR) for the effect of SVR on each EHM using competing risk proportional hazard models. Subgroup analysis by birth cohort, sex, injection drug exposure and genotype was also performed. RESULTS Overall, 10,264 HCV-infected individuals were treated with interferon, of whom 6,023 (59%) achieved SVR. As compared to those that failed treatment, EHM risk was significantly reduced among SVR patients for T2DM (asHR, 0.65; 95% confidence interval [CI], 0.55-0.77), CKD or ESRD (asHR, 0.53; 95%CI, 0.43-0.65), ischemic or hemorrhagic stroke (asHR, 0.73; 95%CI, 0.49-1.09), and mood and anxiety disorders (asHR, 0.82; 95%CI, 0.71-0.95), but not for IHD (asHR, 1.23; 95%CI, 1.03-1.47), MACE (asHR: 0.93; 95%CI: 0.79-1.11) or RA (asHR, 1.09; 95% CI, 0.73-1.64). CONCLUSIONS SVR was associated with a reduction in the risk of several EHMs. Increased uptake of antiviral therapy may reduce the growing burden of EHMs in this population. LAY SUMMARY We estimated rates of chronic comorbidities other than liver disease between those who were cured and those failed HCV treatment. Our findings showed that rates of these non-liver disease were largely reduced for those who were cured with interferon-based HCV treatments. Early HCV treatments could provide many benefits in prevention of various HCV complications beyond liver disease.
completed the cases as per standard of care. The primary end point was selection of an optimum tr... more completed the cases as per standard of care. The primary end point was selection of an optimum treatment regimen as per national guidelines. Secondary end points included time to completion, detection of drug-drug interactions and identification of patient interventions. T-test analysis was completed to assess variation in results between groups. Results: A total of 56 cases were completed per group. Use of the toolkit was associated with selection of an optimum treatment regimen in 92.9% of cases as compared with 60.7% of cases in group B (p < 0.05). Drug-drug interaction detection rates were significantly higher with toolkit use (75% vs 47%;p < 0.05). Participants utilising the toolkit suggested an average of 3.4 interventions per case versus 2 per case in Group B. The toolkit was associated with a longer median time to completion (20 versus 15 minutes), however this was not found to be statistically significant (p:0.060). Conclusion: Study findings confirm the effectiveness of the toolkit in aiding pharmacists in selecting the optimum Hepatitis C treatment regimen. The potential for pharmacists working in all practice environments in Ireland, including community, to make a robust contribution to treatment of Hepatitis C, is something that can be supported using this toolkit. This type of capacity building within our limited healthcare resources is key to upscaling the model of care in Ireland to achieve elimination targets.
To describe the characteristics of people diagnosed with acute and chronic hepatitis B virus (HBV... more To describe the characteristics of people diagnosed with acute and chronic hepatitis B virus (HBV) infection in British Columbia (BC). We used data from the BC Hepatitis Testers Cohort (BC-HTC), which includes all individuals tested for hepatitis C virus (HCV) or human immunodeficiency virus (HIV) or those diagnosed with HBV or active tuberculosis in BC since 1990. These data were integrated with prescription drug, medical visit, hospitalization and mortality data. HBV cases were classified as acute or chronic according to provincial guidelines. We compared characteristics of individuals by HBV infection group (acute, chronic and negative). Factors associated with acute or chronic HBV infection were assessed with multinomial logistic regression models in comparison to the HBV negative group. 46498 of the 1058056 eligible BC-HTC participants were diagnosed with HBV infection. 4.3% of HBV positive individuals were diagnosed with acute HBV infections while 95.7% had chronic infections....
Co-occurrence of social conditions and infections may affect HIV/HCV disease risk and progression... more Co-occurrence of social conditions and infections may affect HIV/HCV disease risk and progression. We examined the changes in relationship of these social conditions and infections on HIV and hepatitis C virus (HCV) infections over time in British Columbia during 1990-2013. The BC Hepatitis Testers Cohort (BC-HTC) includes ~1.5 million individuals tested for HIV or HCV, or reported as a case of HCV, HIV, HBV, or tuberculosis linked to administrative healthcare databases. We classified HCV and HIV infection status into five combinations: HIV-/HCV-, HIV+monoinfected, HIV-/HCV+seroconverters, HIV-/HCV+prevalent, and HIV+/HCV+. Of 1.37 million eligible individuals, 4.1% were HIV-/HCV+prevalent, 0.5% HIV+monoinfected, 0.3% HIV+/HCV+ co-infected and 0.5% HIV-/HCV+seroconverters. Overall, HIV+monoinfected individuals lived in urban areas (92%), had low injection drug use (IDU) (4%), problematic alcohol use (4%) and were materially more privileged than other groups. HIV+/HCV+ co-infected an...
Background: Population-level monitoring of hepatitis C virus (HCV) infected people across the cas... more Background: Population-level monitoring of hepatitis C virus (HCV) infected people across the cascade of care identifies gaps in access and engagement in care and treatment. We characterized a population-level cascade of care for HCV in British Columbia (BC), Canada and identified factors associated with leakage at each stage. Methods: The BC Hepatitis Testers Cohort (BC-HTC) includes 1.5 million individuals tested for HCV, HIV, reported cases of hepatitis B, and active tuberculosis in BC from 1990 to 2013 linked to medical visits, hospitalizations, cancers, prescription drugs and mortality data. We defined six HCV cascade of care stages: 1) estimated population prevalence; 2) HCV diagnosed; 3) HCV RNA tested; 4) genotyped; 5) initiated treatment; and 6) achieved sustained virologic response (SVR). Results: We estimated that 73,203 people were HCV antibody positive in BC in 2012 (undiagnosed: 18,301, 25%; diagnosed: 54,902, 75%). Of these, 56%(40,656) had HCV RNA testing; 34%(26,300) were genotyped; 12%(8532) had received interferon-based therapy and 7%(5197) had SVR. Males, older birth cohorts, and HBV coinfected were less likely to undergo HCV RNA testing. Among those with chronic HCV infection, 32% had received liverrelated care. Retention in liver care was more likely in those with HIV, cirrhosis, and drug/alcohol use and less likely in males and HBV coinfected. Conclusions: Although there are gaps in HCV RNA testing and genotyping after HCV diagnosis, the major gap in the cascade of care was low treatment initiation. People with comorbidities progressed through the cascade of testing and care but few received treatment.
Direct-acting antiviral therapies (DAA) are an important tool for hepatitis C virus (HCV) elimina... more Direct-acting antiviral therapies (DAA) are an important tool for hepatitis C virus (HCV) elimination. However, reinfection among people who inject drugs (PWID) may hamper elimination targets. Therefore, we estimated HCV reinfection rates among DAA-treated individuals, including PWID. We analyzed data from the British Columbia Hepatitis Testers Cohort which included ∼1.7 million individuals screened for HCV in British Columbia, Canada. We followed HCV-infected individuals treated with DAAs who achieved a sustained virologic response (SVR) and had ≥1 subsequent HCV RNA measurement to April 22nd, 2018. Reinfection was defined as a positive RNA measurement after SVR. PWID were identified using a validated algorithm and classified based on recent (<3 years) or former (≥3 years before SVR) use. Crude reinfection rates per 100 person-years (PYs) were calculated. Poisson regression was used to model adjusted incidence rate ratios (IRRs) and 95% CIs. Of 4,114 individuals who met the incl...
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