The Hepatitis C virus (HCV) is a blood borne infection and a leading cause of end-stage liver disease. The World Health Organization estimates that about 58 million people are living with chronic HCV, leading to 290,000 deaths annually due to HCV-related liver illness. Here in Canada, HCV affects a quarter of a million people. Of this quarter million, over 40% are unaware of their infection.
In British Columbia (BC), about two thirds of people living with HCV are baby boomers. However, the number of millennials diagnosed with HCV is increasing, with some reports tying this rise in cases to the drug poisoning crisis, as people who inject drugs (PWID) have an elevated risk of contracting HCV.
The advent of modern HCV treatments, known as direct-acting antivirals (DAAs), has essentially transformed HCV to a curable condition, with successes of over 95 per cent in clearing the virus following 8-12 weeks of oral treatment.
Despite the introduction of these widely successful treatments, pervasive barriers to HCV care persist, which fuel inequities in treatment outcomes. Among PWID, the barriers to care include misconceptions about treatment eligibility, or prescribers hesitant to initiate treatment due to ongoing substance use which raises fears of reinfection. Recent analysis has found that only half of Canadians who suffer from HCV have received DAA treatment, and among PWID, this falls to roughly 40%.
Given these changes in where and how treatment for HCV is offered in BC, BC-CfE researchers sought to find out the status of HCV knowledge among people who recently completed DAA therapy. The resulting study is titled Knowledge of hepatitis C and awareness of reinfection risk among people who successfully completed direct acting antiviral therapy.
The BC-CfE’s Per-SVR (Preservation of Sustained Virologic Response) includes a cohort of patients who have recently achieved a sustained virologic response, i.e. were cured of HCV, after successfully completing DAA therapy. The 227 participants for the recently published study came from the Per-SVR cohort and were tasked with taking an HCV knowledge test.
The researchers assessed HCV knowledge scores overall and created four mutually exclusive key groups to assess knowledge among specific priority populations: PWID, people living with HIV and HCV, PWID and who also live with HIV, and people who don’t inject drugs nor live with HIV. Furthermore, using a latent modeling technique, they identified a group of patients in the cohort with complex conditions who often face challenging barriers to care. These groups include: baby boomers who ever experienced homelessness, women sex workers who ever experienced homelessness, men who inject drug and experienced homelessness and have ever had a diagnosis of mental disorders.
The researchers found that knowledge about HCV, including treatment and reinfection risks, is quite high, even among populations that may face barriers to treatment because of perceived risks for reinfection. The study findings show the importance of barrier-free access to treatment, and contribute to growing evidence demonstrating the need for universal testing and treatment.
In concluding the research, the authors say continued evaluation of HCV knowledge levels among those who complete DAA treatment is critical in ensuring on-going engagement in follow-up care.
About two thirds of clients in the study were treated in community-based settings, not in specialist clinics. We have encouraging data suggesting that in lower-barrier, primary care settings, that there is really high comprehension of the risk of HCV reinfection after being successfully treated with DAA therapy.
– Kiana Yazdani, BC-CfE Research Coordinator with the BC-CfE’s Viral Hepatitis Research Program and the lead author of study