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Background: Historically, hepatitis C virus (HCV) was difficult to treat among people with HIV. However, treatment with direct‐acting antivirals (DAAs) results in 90%–95% of people being cured. There is a need to understand why a proportion of people are not cured. We aimed to examine characteristics that may indicate an increased probability of unsuccessful DAA HCV treatment. Methods: Data were from the International Collaboration on Hepatitis C Elimination in HIV Cohorts. People who commenced DAA HCV treatment between 2014 and 2019 were included. Unsuccessful treatment was defined as a positive HCV RNA test at a person's first RNA test at least 4 weeks (SVR4+) following the end of treatment. Multivariable mixed‐effects logistic regression was used to examine characteristics associated with unsuccessful treatment. Results: Of 4468 people who commenced DAA treatment, 4098 (91.7%) had an SVR test 4+ weeks following the end of treatment, 207 (5%) of whom were unsuccessfully treated. Compared to a CD4+ cell count > 500 cells/mm3, cell counts < 200 (aOR 1.81, 95%CI 1.00–3.29) and between 200 and 349 (aOR 1.95, 95%CI 1.30–2.93) were associated with increased odds of unsuccessful treatment. Among 1921 people with data on injection drug use in the 12 months prior to treatment, there was some evidence that recent injection drug use was associated with increased odds of unsuccessful treatment; however, this was not statistically significant (aOR 1.67, 95%CI 0.99–2.82). Conclusions: The overwhelming majority of people were successfully treated for HCV. Overall, 5% of those with an SVR4+ test were unsuccessfully treated; this was more likely among people with evidence of immunodeficiency and those who reported recently injecting drugs. [ABSTRACT FROM AUTHOR]

Background Hepatitis C virus (HCV) infection has been reported among gay, bisexual, and other men who have sex with men (GBM) globally including GBM with human immunodeficiency virus (HIV) and HIV-negative GBM, particularly those using HIV preexposure prophylaxis (PrEP). In Australia, HCV direct-acting antiviral treatment (DAA) was government-funded from 2016. Large implementation studies of PrEP also began in 2016. We examined HCV incidence among GBM to assess whether HCV incidence has changed since 2015. Methods Data were drawn from the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance. We included GBM who tested HCV antibody negative at their first test and had ≥1 subsequent test. Generalized linear modeling (Poisson distribution) was used to examine HCV incidence from 2009 to 2019 stratified by HIV status, and among HIV-negative GBM prescribed PrEP from 2016 to 2019. Results Among 6744 GBM with HIV, HCV incidence was 1.03 per 100 person-years (PY). Incidence declined by 78% in 2019 compared to 2015 (incidence rate ratio [IRR], 0.22 [95% confidence interval {CI}:.09–.55]). Among 20 590 HIV-negative GBM, HCV incidence was 0.20/100 PY, with no significant change over time. Among 11 661 HIV-negative GBM prescribed PrEP, HCV incidence was 0.29/100 PY. Compared to 2016, incidence among GBM prescribed PrEP declined by 80% in 2019 (IRR, 0.20 [95% CI:.06–.64]). Conclusions HCV incidence among GBM living with HIV declined following DAA availability. There was no observed change in HCV incidence among HIV-negative GBM overall. Among GBM prescribed PrEP, incidence declined since the early years of PrEP implementation in Australia. Australia is on track to eliminate HCV among GBM before global 2030 targets. [ABSTRACT FROM AUTHOR]

Background: Hepatitis C virus (HCV) treatment through primary care and community‐based services will be a critical component of HCV elimination. We evaluated a nurse‐coordinated programme providing care across eight sites and analysed progression through the HCV care cascade. Methods: People‐accessing services from six primary care clinics, a homeless crisis accommodation provider and a mental health service were directly referred to nurses or engaged by nurses during regular clinic visits. Nurses supported HCV testing, treatment and follow‐up. The prescription was provided by affiliated clinicians. Logistic regression was used to examine factors associated with treatment commencement and sustained virological response (SVR) testing. Results: Of 640 people referred to and/or engaged by the nurses from January 2017 to July 2019, 518 had an HCV RNA test of whom 381 (74%) were HCV RNA positive. Treatment was commenced by 281 (74%) people of whom 161 had an SVR test, 157 (97.5%) were cured. Opioid agonist therapy was associated with treatment commencement (aOR 2.68, 95% CI 1.48‐4.88). People who were homeless/unstably housed were less likely to commence treatment (aOR 0.45, 95% CI 0.23‐0.87). Treatment prescription from a specialist (aOR 2.39, 95% CI 1.20‐4.74) and recent injection drug use (<6 months) (aOR 2.15, 95% CI 1.07‐4.31) was associated with SVR testing. Conclusion: A nurse‐coordinated model of care led to high levels of HCV treatment uptake and cure amongst people attending primary care and community services. More tailored models of care may be beneficial for people who are homeless or have unstable housing. These results support primary care and community‐based hepatitis C treatment. [ABSTRACT FROM AUTHOR]

Background: In Australia, the incidence of hepatitis C virus (HCV) infection has declined among gay and bisexual men (GBM) with HIV since 2015 and is low among GBM using HIV pre-exposure prophylaxis (PrEP). However, ongoing HCV testing, and treatment, is required to sustain HCV elimination. Annual HCV testing is recommended in Australia for all GBM with HIV and GBM using PrEP regardless of sexual or substance use behaviours. Bacterial sexually transmissible infections (STIs) are associated with similar behaviours as HCV among GBM, and therefore may be useful to guide more personcentered and tailored HCV testing. To examine this, we measured the association between STIs and HCV from 2016 to 2020. Methods: Data were from a national network of primary care and sexual health clinics participating in the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance (ACCESS). GBM included had at least one HCV antibody negative test during the observation period and ≥1 subsequent HCV test. Discrete time modelling estimated the association between a syphilis, rectal chlamydia, and rectal gonorrhoea diagnosis in the preceding two years on incident HCV infection, reported as an adjusted hazard ratio (aHR). Analyses were stratified by GBM with HIV and GBM prescribed PrEP and adjusted for age and the number of each STI test undertaken. Results: Among 6,529 GBM with HIV, 92 had an incident HCV infection which was associated with a syphilis infection (aHR 1.99, 95%CI:1.11--3.56). Of 13,061 GBM prescribed PrEP, 48 had an incident HCV infection, which was associated with rectal chlamydia (aHR 2.73, 95%CI:1.40--5.30) and rectal gonorrhoea (aHR 2.58, 95%CI:1.30--5.13). Conclusion: HCV was associated with bacterial STIs among GBM with HIV and GBM using PrEP. These findings suggest that an STI diagnosis should prompt a conversation about HCV testing, and that more frequent HCV testing may be justified among GBM with STIs. [ABSTRACT FROM AUTHOR]

Background: Hepatitis C virus (HCV) infection has been reported among gay, bisexual, and other men who have sex with men (GBM) globally including GBM with human immunodeficiency virus (HIV) and HIV-negative GBM, particularly those using HIV preexposure prophylaxis (PrEP). In Australia, HCV direct-acting antiviral treatment (DAA) was government-funded from 2016. Large implementation studies of PrEP also began in 2016. We examined HCV incidence among GBM to assess whether HCV incidence has changed since 2015., Methods: Data were drawn from the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance. We included GBM who tested HCV antibody negative at their first test and had ≥1 subsequent test. Generalized linear modeling (Poisson distribution) was used to examine HCV incidence from 2009 to 2019 stratified by HIV status, and among HIV-negative GBM prescribed PrEP from 2016 to 2019., Results: Among 6744 GBM with HIV, HCV incidence was 1.03 per 100 person-years (PY). Incidence declined by 78% in 2019 compared to 2015 (incidence rate ratio [IRR], 0.22 [95% confidence interval {CI}: .09-.55]). Among 20 590 HIV-negative GBM, HCV incidence was 0.20/100 PY, with no significant change over time. Among 11 661 HIV-negative GBM prescribed PrEP, HCV incidence was 0.29/100 PY. Compared to 2016, incidence among GBM prescribed PrEP declined by 80% in 2019 (IRR, 0.20 [95% CI: .06-.64])., Conclusions: HCV incidence among GBM living with HIV declined following DAA availability. There was no observed change in HCV incidence among HIV-negative GBM overall. Among GBM prescribed PrEP, incidence declined since the early years of PrEP implementation in Australia. Australia is on track to eliminate HCV among GBM before global 2030 targets., (© The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)